Provider Demographics
NPI:1255494845
Name:COLUMBUS URBAN LEAGUE
Entity Type:Organization
Organization Name:COLUMBUS URBAN LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, EDUCATION & PREVENTION
Authorized Official - Prefix:MR
Authorized Official - First Name:O'VELL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-257-6300
Mailing Address - Street 1:788 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1408
Mailing Address - Country:US
Mailing Address - Phone:614-257-6300
Mailing Address - Fax:
Practice Address - Street 1:788 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1408
Practice Address - Country:US
Practice Address - Phone:614-257-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare