Basic Information
| Provider Information | |||||||||
| NPI: | 1295074821 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE CENTER FOR INDIVIDUAL AND FAMILY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 STERKEL BLVD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197561133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270 STERKEL BLVD | ||||||||
| Address2: | 270 STERKEL BLVD | ||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449071508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197561133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2013 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 4197746884 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | S1200452 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.