Provider Demographics
NPI:1841684610
Name:CCHS INC-JOHNSTOWN
Entity type:Organization
Organization Name:CCHS INC-JOHNSTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-272-3272
Mailing Address - Street 1:540 INDUSTRIAL MILE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-279-5742
Mailing Address - Fax:614-279-1922
Practice Address - Street 1:5006 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9519
Practice Address - Country:US
Practice Address - Phone:614-245-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS CENTER FOR HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2500243251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0536521Medicaid
OH2500243Medicaid