Provider Demographics
NPI:1235493990
Name:MIFFLIN YOUTH GROUP
Entity Type:Organization
Organization Name:MIFFLIN YOUTH GROUP
Other - Org Name:MIFFLIN YOUTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-456-6029
Mailing Address - Street 1:1688 SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1500
Mailing Address - Country:US
Mailing Address - Phone:614-456-6029
Mailing Address - Fax:
Practice Address - Street 1:1688 SCHROCK RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1500
Practice Address - Country:US
Practice Address - Phone:614-456-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076471273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit