1811966401 NPI number — STATE OF OHIO DEPARTMENT OF MENTAL HEALTH

Table of content: (NPI 1811966401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811966401 NPI number — STATE OF OHIO DEPARTMENT OF MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF OHIO DEPARTMENT OF MENTAL HEALTH
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:
SB - SUMMIT BEHAVIORAL HEALTH CSN
Provider Other Organization Name Type Code:
3
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:
1811966401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E. BROAD ST
Provider Second Line Business Mailing Address:
11TH FLOOR - FISCAL ADMINISTRATION
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-3430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-466-6583
Provider Business Mailing Address Fax Number:
614-644-5331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 SUMMIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45237-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-948-3600
Provider Business Practice Location Address Fax Number:
513-948-3080
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FASONE
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
FISCAL MANAGER
Authorized Official Telephone Number:
614-466-9930

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , 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: 10343 . This is a "MACSIS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2589293 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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