Basic Information
| Provider Information | |||||||||
| NPI: | 1417496233 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMPOWERED FOR EXCELLENCE BEHAVIORAL HEALTH OHIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3170 W CENTRAL AVE STE B | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436062945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5673167253 | ||||||||
| FaxNumber: | 5673167232 | ||||||||
| Practice Location | |||||||||
| Address1: | 3170 W CENTRAL AVE STE B | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436062945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5673167253 | ||||||||
| FaxNumber: | 5673167232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2017 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5673167253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | 13787 | OH | N | Agencies | Case Management | 251S00000X | 01-7525 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 01-7525 | 05 | OH | MEDICAID | 13787 | 05 | OH | MEDICAID |