Provider Demographics
NPI:1073064010
Name:COLUMBUS CENTER FOR HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:COLUMBUS CENTER FOR HUMAN SERVICES, INC.
Other - Org Name:EVENING STREET ICF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-641-2901
Mailing Address - Street 1:540 INDUSTRIAL MILE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-2413
Mailing Address - Country:US
Mailing Address - Phone:614-641-2900
Mailing Address - Fax:614-278-1125
Practice Address - Street 1:6535 EVENING ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3058
Practice Address - Country:US
Practice Address - Phone:614-641-2900
Practice Address - Fax:614-278-1125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS CENTER FOR HUMAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2500243251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0536521Medicaid
OH2500243Medicaid
OH0119090Medicaid
OH0842131Medicaid