MEDICARE: COMPLETE HEALTH CARE FOR WOMEN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	061029	OH

General Provider Information

NPI Number	:	1760728661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HEALTH CARE FOR WOMEN INC

Provider Business Mailing Address
First Line	:	5888 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2815
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

Provider Business Practice Location Address
First Line	:	5888 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-2815
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL RESEARCH
Name	:	DR. MILROY J SAMUEL
Credential	:	M.D.
Telephone Number	:	614-578-8582

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	12/20/2012

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