Provider Demographics
NPI:1306354691
Name:HORNE, QUATISHA M
Entity type:Individual
Prefix:
First Name:QUATISHA
Middle Name:M
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1459
Mailing Address - Country:US
Mailing Address - Phone:614-772-2722
Mailing Address - Fax:
Practice Address - Street 1:1500 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1459
Practice Address - Country:US
Practice Address - Phone:614-589-1397
Practice Address - Fax:614-589-1397
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator