# PASSPORT HEALTH OHIO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Passport Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396175287
- **Authorized official:** VICKI SOWARDS (CLINICAL RN SUPERVIS)
- **Authorized official phone:** (888) 909-6551

## Contact information

- **Practice address:** 38 BOLAND CT, GREENVILLE, SC 29615
- **Practice address phone:** (888) 909-6551
- **Practice address fax:** (480) 383-6567
- **Mailing address:** 6710 E CAMELBACK RD, SCOTTSDALE, AZ 85251
- **Mailing address phone:** (888) 909-6551
- **Mailing address fax:** (480) 383-6567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | SC | Yes |

## Other

- **Enumeration date:** 11/14/2013
- **Last updated:** 11/14/2013