Provider Demographics
NPI:1790475804
Name:ONE COMMUNITY DEVELOPMENTAL SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:ONE COMMUNITY DEVELOPMENTAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GODFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-SEKYERE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:614-906-4292
Mailing Address - Street 1:325 WOODFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-3536
Mailing Address - Country:US
Mailing Address - Phone:614-906-4292
Mailing Address - Fax:614-396-8841
Practice Address - Street 1:1425 E DUBLIN GRANVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3312
Practice Address - Country:US
Practice Address - Phone:614-906-4292
Practice Address - Fax:614-396-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities