| Enliven Resource | |
|
929 Harrison Ave 304 Columbus OH 43215-1346 | |
| (614) 940-4868 | |
| (614) 923-7525 |
| Full Name | Enliven Resource |
|---|---|
| Speciality | Social Worker |
| Location | 929 Harrison Ave, Columbus, Ohio |
| Authorized Official Name and Position | Brock Allan Bauer (OWNER) |
| Authorized Official Contact | 6149404868 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enliven Resource 929 Harrison Ave 304 Columbus OH 43215-1346 Ph: (614) 940-4868 | Enliven Resource 929 Harrison Ave 304 Columbus OH 43215-1346 Ph: (614) 940-4868 |
| NPI Number | 1376820209 |
|---|---|
| Provider Enumeration Date | 11/06/2011 |
| Last Update Date | 01/01/2013 |
| Medicare PECOS PAC ID | 9537304530 |
|---|---|
| Medicare Enrollment ID | O20130322000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376820209 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I.0700102-SUPV (Ohio) | Primary |
| Provider Name | John B Hollis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376694539 PECOS PAC ID: 6901063601 Enrollment ID: I20120208000572 |
| Provider Name | Brock A Bauer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407090897 PECOS PAC ID: 5991940991 Enrollment ID: I20130322000065 |
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