Provider Demographics
NPI:1851507180
Name:HEINZERLING DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:HEINZERLING DEVELOPMENTAL CENTER
Other - Org Name:HEINZERLING FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:N. CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-272-8888
Mailing Address - Street 1:1755 HEINZERLING DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3672
Mailing Address - Country:US
Mailing Address - Phone:614-272-2000
Mailing Address - Fax:614-272-2050
Practice Address - Street 1:1755 HEINZERLING DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3672
Practice Address - Country:US
Practice Address - Phone:614-272-2000
Practice Address - Fax:614-272-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0509766320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36G122Medicaid
OH0509766OtherMRDD LICENSURE