1821059916 NPI number — FAMILY SERVICE OF NORTHWEST OHIO

Table of content: (NPI 1821059916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821059916 NPI number — FAMILY SERVICE OF NORTHWEST OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE OF NORTHWEST OHIO
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:
6
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:
1821059916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 JEFFERSON
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-244-5511
Provider Business Mailing Address Fax Number:
419-321-6459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7320 STATE HIGHWAY 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43567-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-335-3732
Provider Business Practice Location Address Fax Number:
419-335-3462
Provider Enumeration Date:
03/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
419-244-5511

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  0180 , 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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