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Organization

PERIDOT CARE SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TRACY OCONNOR (OWNER/ADMINISTRATOR)
(614) 268-2219
Entity
Organization

Contact information

Practice address
270 E KELSO RD, COLUMBUS, OH 43202-2306
(614) 268-2219
(614) 268-0644
Mailing address
270 E KELSO RD, COLUMBUS, OH 43202-2306
(614) 268-2219
(614) 268-0644

Taxonomy

Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
28536
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0063506
OH
Enumeration date
10/21/2012
Last updated
02/05/2014
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