Peridot Care Services, LLC

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

28536 Issued in OH

Legal business name

PERIDOT CARE SERVICES, LLC

Practice address

270 E Kelso Rd
Columbus, OH 43202-2306

Phone

(614) 268-2219

Fax

(614) 268-0644

NPI assigned

Oct 21, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy Oconnor

Title

Owner/Administrator

Phone

(614) 268-2219

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391558400000",
    "number": "1902159494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 E KELSO RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432022306",
            "telephone_number": "614-268-2219",
            "fax_number": "614-268-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E KELSO RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432022306",
            "telephone_number": "614-268-2219",
            "fax_number": "614-268-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIDOT CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-21",
        "last_updated": "2014-02-05",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "614-268-2219"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "OH",
            "license": "28536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0063506",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.