Provider Demographics
NPI:1962243600
Name:RESILIENT CHILDREN AND FAMILIES
Entity type:Organization
Organization Name:RESILIENT CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MASON
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-361-5552
Mailing Address - Street 1:2175 S JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3850
Mailing Address - Country:US
Mailing Address - Phone:614-826-0082
Mailing Address - Fax:614-826-0182
Practice Address - Street 1:2175 S JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3850
Practice Address - Country:US
Practice Address - Phone:614-826-0082
Practice Address - Fax:614-826-0182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESILIENT CHILDREN AND FAMILIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0023102Medicaid