Basic Information
| Provider Information | |||||||||
| NPI: | 1669437653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CENTRAL MENTAL HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432012460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142996600 | ||||||||
| FaxNumber: | 6144213111 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432012460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142996600 | ||||||||
| FaxNumber: | 6144213111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | NIEDZWIEDSKI | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6142996600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 1197 | OH | N | Agencies | Case Management | 261QM0850X | 0298 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 0298 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 324500000X | 2558 | OH | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QM0801X | 0298 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 0274411 | 05 | OH | MEDICAID | 0004542190 | 01 | OH | AETNA | OTHER |