Provider Demographics
NPI:1912186156
Name:POWER OF ONE SUPPORT CENTER AGENCY, INC
Entity Type:Organization
Organization Name:POWER OF ONE SUPPORT CENTER AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-527-7756
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0974
Mailing Address - Country:US
Mailing Address - Phone:614-527-7756
Mailing Address - Fax:614-527-7756
Practice Address - Street 1:3220 LOWELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-4121
Practice Address - Country:US
Practice Address - Phone:614-527-7756
Practice Address - Fax:614-527-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1730189OtherAGENCY