| NPI | 1114346459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH RUTHERFORD Service Line Administrator 614-722-2290 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2014-04-15 |