Provider Demographics
NPI:1972540037
Name:OHIO DEPARTMENT OF YOUTH SERVICES
Entity Type:Organization
Organization Name:OHIO DEPARTMENT OF YOUTH SERVICES
Other - Org Name:FREEDOM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:JANNING
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:614-644-6449
Mailing Address - Street 1:51 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3031
Mailing Address - Country:US
Mailing Address - Phone:614-644-6449
Mailing Address - Fax:614-466-8656
Practice Address - Street 1:8101 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8892
Practice Address - Country:US
Practice Address - Phone:740-881-3337
Practice Address - Fax:740-881-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH29053245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2905Medicare UPIN