Basic Information
| Provider Information | |||||||||
| NPI: | 1487614889 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACHIEVEMENT CENTERS FOR CHILDREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4255 NORTHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162929700 | ||||||||
| FaxNumber: | 2163784613 | ||||||||
| Practice Location | |||||||||
| Address1: | 4255 NORTHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162929700 | ||||||||
| FaxNumber: | 2163784613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | FARWELL | ||||||||
| AuthorizedOfficialFirstName: | SALLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 2162929700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.ED. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 225X00000X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | OH | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0028740 | 05 | OH | MEDICAID |