Provider Demographics
NPI:1164069175
Name:INSTITUTE OF POSITIVE CHANGE, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF POSITIVE CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-668-8411
Mailing Address - Street 1:PO BOX 83058
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-0058
Mailing Address - Country:US
Mailing Address - Phone:614-668-8411
Mailing Address - Fax:614-824-3687
Practice Address - Street 1:223 MAYFAIR BLVD APT D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2212
Practice Address - Country:US
Practice Address - Phone:614-668-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0368295Medicaid