1134452576 NPI number — FORENSIC PSYCHIATRIC CENTER OF NORTHEAST OHIO, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134452576 NPI number — FORENSIC PSYCHIATRIC CENTER OF NORTHEAST OHIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORENSIC PSYCHIATRIC CENTER OF NORTHEAST OHIO, 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:
1134452576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5212 MAHONING AVE
Provider Second Line Business Mailing Address:
SUITE 317
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44515-1857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-792-1918
Provider Business Mailing Address Fax Number:
330-792-7712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5212 MAHONING AVE
Provider Second Line Business Practice Location Address:
SUITE 317
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44515-1857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-792-1918
Provider Business Practice Location Address Fax Number:
330-792-7712
Provider Enumeration Date:
09/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HEINBAUGH
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
330-792-1918

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  295 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 295 , 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)





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