1457874380 NPI number — STRIVING FOR GREATNESS GROUP HOME LLC

Table of content: (NPI 1457874380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457874380 NPI number — STRIVING FOR GREATNESS GROUP HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRIVING FOR GREATNESS GROUP HOME LLC
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:
1457874380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 S 3RD ST STE 210
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:
43215-4206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-679-4098
Provider Business Mailing Address Fax Number:
614-695-3115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1071 SEYMOUR AVE
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:
43206-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-679-4098
Provider Business Practice Location Address Fax Number:
614-695-3115
Provider Enumeration Date:
07/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BRINKLEY
Authorized Official First Name:
TRESSA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-679-4098

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , 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)





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