Provider Demographics
NPI:1255835666
Name:INTEGRATIVE HEALTH NETWORK LLC
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-634-2405
Mailing Address - Street 1:7652 SAWMILL RD STE 311
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9296
Mailing Address - Country:US
Mailing Address - Phone:614-634-2405
Mailing Address - Fax:
Practice Address - Street 1:169 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7619
Practice Address - Country:US
Practice Address - Phone:614-634-2405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1871008987Medicaid