1710110978 NPI number — PERSON CENTERED SERVICES, INC

Table of content: (NPI 1710110978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710110978 NPI number — PERSON CENTERED SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSON CENTERED 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:
1710110978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 REFUGEE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43147-9694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-856-2123
Provider Business Mailing Address Fax Number:
614-856-1697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 REFUGEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKERINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43147-9694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-856-2123
Provider Business Practice Location Address Fax Number:
614-856-1697
Provider Enumeration Date:
09/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALBERT
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-856-2123

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2301173 . This is a "OHIO DEPARTMENT OF MRDD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com