Provider Demographics
NPI:1487068581
Name:SOURCEPOINT
Entity type:Organization
Organization Name:SOURCEPOINT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-203-2353
Mailing Address - Street 1:800 CHESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-6038
Mailing Address - Country:US
Mailing Address - Phone:740-363-6677
Mailing Address - Fax:740-363-7588
Practice Address - Street 1:800 CHESHIRE RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-6038
Practice Address - Country:US
Practice Address - Phone:740-363-6677
Practice Address - Fax:740-363-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050622Medicaid