1740451756 NPI number — PSYCHOLOGICAL HEALTH CENTER & ALCOHOLISM TREATMENT PROGRAM, INC.

Table of content: (NPI 1740451756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740451756 NPI number — PSYCHOLOGICAL HEALTH CENTER & ALCOHOLISM TREATMENT PROGRAM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOLOGICAL HEALTH CENTER & ALCOHOLISM TREATMENT PROGRAM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740451756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6315 PEARL RD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
PARMA HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-3074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-845-9061
Provider Business Mailing Address Fax Number:
440-845-9062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6315 PEARL RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
PARMA HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-3074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-845-9061
Provider Business Practice Location Address Fax Number:
440-845-9062
Provider Enumeration Date:
03/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SABATAITIS
Authorized Official First Name:
GINTAUTAS
Authorized Official Middle Name:
Z.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-845-9061

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  1436 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093784811 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0251561 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".