1669437653 NPI number — NORTH CENTRAL MENTAL HEALTH SERVICES, INC.

Table of content: (NPI 1669437653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669437653 NPI number — NORTH CENTRAL MENTAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL MENTAL HEALTH SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669437653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 N HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43201-2460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-299-6600
Provider Business Mailing Address Fax Number:
614-421-3111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 N HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43201-2460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-299-6600
Provider Business Practice Location Address Fax Number:
614-421-3111
Provider Enumeration Date:
04/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NIEDZWIEDSKI
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-299-6600

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  1197 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 0298 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 0298 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 0298 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 2558 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0274411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004542190 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".