| Alvis House | |
|
2100 Stella Ct Columbus OH 43215-1011 | |
| (614) 252-8402 | |
| (614) 252-5326 |
| Full Name | Alvis House |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2100 Stella Ct, Columbus, Ohio |
| Authorized Official Name and Position | Denise M. Robinson (PRESIDENT AND CEO) |
| Authorized Official Contact | 6142528402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alvis House 2100 Stella Ct Columbus OH 43215-1011 Ph: (614) 252-8402 | Alvis House 2100 Stella Ct Columbus OH 43215-1011 Ph: (614) 252-8402 |
| NPI Number | 1386993350 |
|---|---|
| Provider Enumeration Date | 09/05/2012 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 2264764299 |
|---|---|
| Medicare Enrollment ID | O20191024001619 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386993350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 13153 (Ohio) | Primary |
| Provider Name | Michelle L Fridman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376900191 PECOS PAC ID: 0749587483 Enrollment ID: I20160324000735 |
| Provider Name | Anna Hung-chan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881064004 PECOS PAC ID: 3072811413 Enrollment ID: I20160418002016 |
| Provider Name | Sara A Mcintosh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649483611 PECOS PAC ID: 3971894692 Enrollment ID: I20160627001958 |
| Provider Name | Dana Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871047571 PECOS PAC ID: 3274961651 Enrollment ID: I20200318000758 |
| Provider Name | Randall Shively |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235608084 PECOS PAC ID: 2860822798 Enrollment ID: I20200416003440 |
| Provider Name | Alexis R Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053972109 PECOS PAC ID: 1355758731 Enrollment ID: I20210331002120 |
| Provider Name | Ossie M Dornoo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114650579 PECOS PAC ID: 8729450879 Enrollment ID: I20230217002202 |
| Provider Name | Adele L Johnson-moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598117228 PECOS PAC ID: 6800224338 Enrollment ID: I20240106000611 |
| Provider Name | Carol Hayden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346696697 PECOS PAC ID: 0446602650 Enrollment ID: I20240123002715 |
| Provider Name | Tonya Mabra |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942746409 PECOS PAC ID: 4082067277 Enrollment ID: I20240124000722 |
| Provider Name | Jeffrey L Greer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063640506 PECOS PAC ID: 7911350962 Enrollment ID: I20240126000648 |
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