Provider Demographics
NPI:1912706466
Name:JEREMIAHS CORNER LLC
Entity type:Organization
Organization Name:JEREMIAHS CORNER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:614-721-4422
Mailing Address - Street 1:170 NORTHWOODS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4711
Mailing Address - Country:US
Mailing Address - Phone:614-721-4422
Mailing Address - Fax:
Practice Address - Street 1:170 NORTHWOODS BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4711
Practice Address - Country:US
Practice Address - Phone:614-721-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, ChildGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services