Organization
EASTON PROVIDER SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOSEPHINE N TALIEH RT (PRESIDENT)
(614) 352-7092
Entity
Organization
Contact information
Practice address
6100 CHANNINGWAY BLVD STE 508, COLUMBUS, OH 43232-2910
(614) 352-7092
(614) 890-1161
Mailing address
6100 CHANNINGWAY BLVD STE 508, COLUMBUS, OH 43232-2910
(614) 352-7092
(614) 890-1161
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
2526609
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2526609
DODD CONTRACT NUMBER
OH
01
—
2570141
ODJFS MEDICAID PROVIDER NUMBER
OH
Enumeration date
09/24/2013
Last updated
09/24/2013
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