Basic Information
Provider Information | |||||||||
NPI: | 1861893109 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FAMILY SERVICE OF NORTHWEST OHIO | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | COMPREHENSIVE CRISIS CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 701 JEFFERSON AVE STE 301 | ||||||||
Address2: |   | ||||||||
City: | TOLEDO | ||||||||
State: | OH | ||||||||
PostalCode: | 436046957 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4192445511 | ||||||||
FaxNumber: | 4193216459 | ||||||||
Practice Location | |||||||||
Address1: | 600 FREEDOM DR | ||||||||
Address2: |   | ||||||||
City: | NAPOLEON | ||||||||
State: | OH | ||||||||
PostalCode: | 435459038 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195991660 | ||||||||
FaxNumber: | 4195928336 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/05/2014 | ||||||||
LastUpdateDate: | 09/05/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JONES | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: | E. | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
AuthorizedOfficialTelephone: | 4192445511 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 06-7511 | OH | Y |   | Agencies | Community/Behavioral Health |   |
No ID Information.