Provider Demographics
NPI:1730513391
Name:POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Entity type:Organization
Organization Name:POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:614-223-1650
Mailing Address - Street 1:765 PIERCE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2425
Mailing Address - Country:US
Mailing Address - Phone:614-223-1650
Mailing Address - Fax:888-727-7834
Practice Address - Street 1:765 PIERCE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2425
Practice Address - Country:US
Practice Address - Phone:614-223-1650
Practice Address - Fax:888-727-7834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH CARE MANAGEMENT SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07-5476283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364045Medicare PIN