Provider Demographics
NPI:1518379296
Name:OHIO DEPARTMENT OF REHABILITATION AND CORRECTIONS
Entity Type:Organization
Organization Name:OHIO DEPARTMENT OF REHABILITATION AND CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / ODRC
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-752-1164
Mailing Address - Street 1:770 WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222
Mailing Address - Country:US
Mailing Address - Phone:740-852-2454
Mailing Address - Fax:740-845-3373
Practice Address - Street 1:770 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1419
Practice Address - Country:US
Practice Address - Phone:614-752-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001345251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health