Organization
FOUNDATION OF LOVE FOR YOUTH, LLC (FLY HOUSE)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRA NICOLE MARTIN LMSW, CDCA, CPLC (SOCIAL WORKER)
(614) 598-9891
Entity
Organization
Contact information
Practice address
850 OAK ST, COLUMBUS, OH 43205-1113
(614) 429-3843
(614) 675-7537
Mailing address
PO BOX 992, REYNOLDSBURG, OH 43068-0992
(614) 429-3843
(614) 675-7537
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251B00000X
Case Management Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881064004
—
OH
Enumeration date
11/27/2021
Last updated
11/27/2021
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