1326002122 NPI number — OHIO YOUTH ADVOCATE PROGRAM

Table of content: (NPI 1326002122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326002122 NPI number — OHIO YOUTH ADVOCATE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO YOUTH ADVOCATE PROGRAM
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:
1326002122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6233 RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-5069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-717-8000
Provider Business Mailing Address Fax Number:
614-717-8020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 SUMMIT 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:
43201-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-523-1001
Provider Business Practice Location Address Fax Number:
614-583-1003
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
614-921-2111

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  353 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 10709 , 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: 10178 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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