Basic Information
| Provider Information | |||||||||
| NPI: | 1215947809 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ZEPF CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ZEPF COMMUNITY MENTAL HEALTH CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6605 WEST CENTRAL AVENUE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198417701 | ||||||||
| FaxNumber: | 4198411691 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 ASHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436201703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198417701 | ||||||||
| FaxNumber: | 4198411691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | NUTT | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4198417701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 0202060 | 05 | OH | MEDICAID | 2480739 | 05 | OH | MEDICAID |