Provider Demographics
NPI:1659148641
Name:E.C.H.O. RESIDENTIAL SUPPORT INC.
Entity Type:Organization
Organization Name:E.C.H.O. RESIDENTIAL SUPPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-210-0944
Mailing Address - Street 1:6500 BUSCH BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6708
Mailing Address - Country:US
Mailing Address - Phone:937-623-0459
Mailing Address - Fax:
Practice Address - Street 1:6500 BUSCH BLVD STE 215
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6708
Practice Address - Country:US
Practice Address - Phone:614-210-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities