Provider Demographics
NPI:1619014537
Name:AVADA OF CENTRAL OHIO, INC.
Entity Type:Organization
Organization Name:AVADA OF CENTRAL OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RIGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-439-6647
Mailing Address - Street 1:141 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2464
Mailing Address - Country:US
Mailing Address - Phone:740-439-6647
Mailing Address - Fax:740-439-9303
Practice Address - Street 1:141 S 11TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2464
Practice Address - Country:US
Practice Address - Phone:740-439-6647
Practice Address - Fax:740-439-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01557231H00000X
OHA01130231H00000X
OH02814237600000X
OH2333237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty