Provider Demographics
NPI:1891525242
Name:WOODS, TAQUALA (CEO)
Entity type:Individual
Prefix:
First Name:TAQUALA
Middle Name:
Last Name:WOODS
Suffix:
Gender:
Credentials:CEO
Other - Prefix:
Other - First Name:TAQUALA
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2234 S HAMILTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4389
Mailing Address - Country:US
Mailing Address - Phone:614-390-4595
Mailing Address - Fax:
Practice Address - Street 1:2234 S HAMILTON RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4389
Practice Address - Country:US
Practice Address - Phone:614-390-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHTS115546172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171M00000XOther Service ProvidersCase Manager/Care Coordinator