Provider Demographics
NPI:1255408316
Name:VIAQUEST HEALTHCARE
Entity type:Organization
Organization Name:VIAQUEST HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-889-5837
Mailing Address - Street 1:525 METRO PL N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-5342
Mailing Address - Country:US
Mailing Address - Phone:614-889-5837
Mailing Address - Fax:614-889-5847
Practice Address - Street 1:6493 ROSELAWN AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2813
Practice Address - Country:US
Practice Address - Phone:614-501-8614
Practice Address - Fax:614-501-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2514106320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600439Medicaid