Basic Information
| Provider Information | |||||||||
| NPI: | 1033288501 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR CHILD AND FAMILY ADVOCACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 219 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435451698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195920540 | ||||||||
| FaxNumber: | 4195924514 | ||||||||
| Practice Location | |||||||||
| Address1: | 219 E WASHINGTON ST | ||||||||
| Address2: | SUITE 219 | ||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435451698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195920540 | ||||||||
| FaxNumber: | 4195924514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 02/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | ESPINOZA | ||||||||
| AuthorizedOfficialFirstName: | AMANDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4195920540 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 2098322 | 05 | OH | MEDICAID |