Provider Demographics
NPI:1881290831
Name:GORDON, TOMIKA
Entity type:Individual
Prefix:
First Name:TOMIKA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 S HAMILTON RD STE 101C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4390
Mailing Address - Country:US
Mailing Address - Phone:855-519-2787
Mailing Address - Fax:
Practice Address - Street 1:2244 S HAMILTON RD STE 101C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4390
Practice Address - Country:US
Practice Address - Phone:855-519-2787
Practice Address - Fax:614-868-1688
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness