| Ncr Permanent Supportive Housing Services | |
|
398 S Grant Ave Columbus OH 43215-5549 | |
| (614) 224-2988 | |
| (614) 716-0901 |
| Full Name | Ncr Permanent Supportive Housing Services |
|---|---|
| Speciality | Case Management |
| Location | 398 S Grant Ave, Columbus, Ohio |
| Authorized Official Name and Position | Susan Dimickele (PRESIDENT) |
| Authorized Official Contact | 6144512151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ncr Permanent Supportive Housing Services 2335 N Bank Dr Columbus OH 43220-5423 Ph: (614) 451-2151 | Ncr Permanent Supportive Housing Services 398 S Grant Ave Columbus OH 43215-5549 Ph: (614) 224-2988 |
| NPI Number | 1003184367 |
|---|---|
| Provider Enumeration Date | 12/01/2011 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 2567720683 |
|---|---|
| Medicare Enrollment ID | O20171219002660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003184367 | NPI | - | NPPES |
| 0060117 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Andrea Shields |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205136207 PECOS PAC ID: 8022251404 Enrollment ID: I20130904000506 |
| Provider Name | Robyn Kay Haycook |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538408455 PECOS PAC ID: 2961760095 Enrollment ID: I20171219003003 |
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