Individual
JAZ CICERO SANTANA BOYCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3118 HOUSTON DR, COLUMBUS, OH 43207-3398
(614) 407-6352
Mailing address
3118 HOUSTON DR, COLUMBUS, OH 43207-3398
(614) 407-6352
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
07/16/2016
Last updated
06/06/2023
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