Basic Information
| Provider Information | |||||||||
| NPI: | 1528563079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY TEACHING HOMES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 400 | ||||||||
| Address2: | |||||||||
| City: | HOLLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435280400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198681178 | ||||||||
| FaxNumber: | 4198681989 | ||||||||
| Practice Location | |||||||||
| Address1: | 6715 DORR ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436154207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198681178 | ||||||||
| FaxNumber: | 4198681178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 04/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARVEY | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4198681178 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 01-0618 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 0247395 | 05 | OH | MEDICAID |