Provider Demographics
NPI:1760037451
Name:GODS PUPIL
Entity Type:Organization
Organization Name:GODS PUPIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:614-407-9269
Mailing Address - Street 1:5195 HAMPSTED VILLAGE CENTER WAY
Mailing Address - Street 2:PMB 119
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8331
Mailing Address - Country:US
Mailing Address - Phone:614-407-9269
Mailing Address - Fax:
Practice Address - Street 1:5098 HEARTHSTONE PARK DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-7900
Practice Address - Country:US
Practice Address - Phone:740-919-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANS PUPIL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316095Medicaid