Provider Demographics
NPI:1255671756
Name:OHIO HOSPITAL FOR PSYCHIATRY, LLC
Entity type:Organization
Organization Name:OHIO HOSPITAL FOR PSYCHIATRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JIVIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-449-9664
Mailing Address - Street 1:880 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2616
Mailing Address - Country:US
Mailing Address - Phone:614-449-9664
Mailing Address - Fax:614-445-7509
Practice Address - Street 1:880 GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2616
Practice Address - Country:US
Practice Address - Phone:614-449-9664
Practice Address - Fax:614-445-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12-2479251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2396090Medicaid
OH2396090Medicaid