Provider Demographics
NPI:1669437653
Name:NORTH CENTRAL MENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:NORTH CENTRAL MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEDZWIEDSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-299-6600
Mailing Address - Street 1:1301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2460
Mailing Address - Country:US
Mailing Address - Phone:614-299-6600
Mailing Address - Fax:614-421-3111
Practice Address - Street 1:1301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2460
Practice Address - Country:US
Practice Address - Phone:614-299-6600
Practice Address - Fax:614-421-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1197251B00000X
OH0298261QM0850X, 261QM0855X, 261QM0801X
OH2558324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274411Medicaid
OH0004542190OtherAETNA
OH01197Medicare UPIN
OH9147532Medicare PIN