Provider Demographics
NPI:1124674072
Name:NORTH DROP BACK IN ACADEMY
Entity type:Organization
Organization Name:NORTH DROP BACK IN ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:614-252-4656
Mailing Address - Street 1:3377 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3644
Mailing Address - Country:US
Mailing Address - Phone:614-252-4656
Mailing Address - Fax:
Practice Address - Street 1:3377 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3644
Practice Address - Country:US
Practice Address - Phone:614-252-4656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency