Provider Demographics
NPI:1588837728
Name:POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Entity Type:Organization
Organization Name:POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Other - Org Name:POMEGRANATE HEALTH SYSTEMS OF COLUMBUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASIRAJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-281-7011
Mailing Address - Street 1:65418 BARKCAMP PARK RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9733
Mailing Address - Country:US
Mailing Address - Phone:740-782-1211
Mailing Address - Fax:877-662-2747
Practice Address - Street 1:765 PIERCE DR.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223
Practice Address - Country:US
Practice Address - Phone:614-223-1650
Practice Address - Fax:888-727-7834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CARE MANAGEMENT SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10-5476283Q00000X
OH10-2068323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066655Medicaid
364045Medicare PIN