1184776957 NPI number — ONE HEALTHCARE CENTER, INC.

Table of content: (NPI 1184776957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184776957 NPI number — ONE HEALTHCARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE HEALTHCARE CENTER, 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:
6
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:
1184776957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 470
Provider Second Line Business Mailing Address:
100 CORRY ST.
Provider Business Mailing Address City Name:
YELLOW SPRINGS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45387-0470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-767-2733
Provider Business Mailing Address Fax Number:
937-767-2736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 CORRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YELLOW SPRINGS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45387-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-767-2733
Provider Business Practice Location Address Fax Number:
937-767-2736
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORST
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-767-2733

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2168 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2055716 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280509362-00 . This is a "WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000211047 . This is a "ANTHEM BLUE CROSS&BLUE SH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: BO0842481 . This is a "MEDICARE INDIVIDUAL PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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