Provider Demographics
NPI:1568635928
Name:DIVERSIFIED COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:DIVERSIFIED COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BORGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-252-8688
Mailing Address - Street 1:1651 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2118
Mailing Address - Country:US
Mailing Address - Phone:614-252-8688
Mailing Address - Fax:614-252-6787
Practice Address - Street 1:479 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2566
Practice Address - Country:US
Practice Address - Phone:614-252-8688
Practice Address - Fax:614-252-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12656101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12656Medicare UPIN