Basic Information
| Provider Information | |||||||||
| NPI: | 1447408018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNISON BEHAVIORAL HEALTH GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544 E WOODRUFF AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436045342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
| FaxNumber: | 4199367606 | ||||||||
| Practice Location | |||||||||
| Address1: | 544 E WOODRUFF AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436045342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196930631 | ||||||||
| FaxNumber: | 4199367606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2008 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4196930631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 231 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 2482013 | 05 | OH | MEDICAID |