Provider Demographics
NPI:1285985796
Name:PREVENTIVE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:PREVENTIVE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:ZARRIEFF
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:614-937-8312
Mailing Address - Street 1:5118 PEACH CANYON DR
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8421
Mailing Address - Country:US
Mailing Address - Phone:614-937-8312
Mailing Address - Fax:
Practice Address - Street 1:5118 PEACH CANYON DR
Practice Address - Street 2:SUITE 503
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8421
Practice Address - Country:US
Practice Address - Phone:614-937-8312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN263403251J00000X, 251K00000X, 251V00000X, 261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable