Provider Demographics
NPI:1366896292
Name:PIPELINE TO GOD COMMUNICATIONS, INC
Entity type:Organization
Organization Name:PIPELINE TO GOD COMMUNICATIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARQUETA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-360-9343
Mailing Address - Street 1:4517 RENAISSANCE PKWY
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5701
Mailing Address - Country:US
Mailing Address - Phone:216-360-9343
Mailing Address - Fax:216-360-9345
Practice Address - Street 1:4517 RENAISSANCE PKWY
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5701
Practice Address - Country:US
Practice Address - Phone:216-360-9343
Practice Address - Fax:216-360-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01-7543251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155473Medicaid