1548611486 NPI number — HORTENCIA DENISE HARRISON LISW, MSW

Table of content: ZI ROGER ZHANG M.D (NPI 1487005351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548611486 NPI number — HORTENCIA DENISE HARRISON LISW, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
HORTENCIA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARIZPE
Provider Other First Name:
HORTENCIA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548611486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 ZOLLINGER RD FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER ARLINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43221-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 ZOLLINGER RD FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER ARLINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-293-2130
Provider Business Practice Location Address Fax Number:
614-293-3087
Provider Enumeration Date:
06/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6731 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I.1901618 , 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: 1548611486 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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