1982259693 NPI number — FAMILY GUIDANCE CENTERS OF OHIO, INC.

Table of content: (NPI 1982259693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982259693 NPI number — FAMILY GUIDANCE CENTERS OF OHIO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY GUIDANCE CENTERS OF 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:
1982259693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2618 PATRIOT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026-8024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-659-7030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4354 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-442-7145
Provider Business Practice Location Address Fax Number:
419-389-0306
Provider Enumeration Date:
08/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
IDE
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE SPECIALIST
Authorized Official Telephone Number:
224-659-7030

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01-7760 . This is a "OHIO MENTAL HEALTH & ADDICTION SERVICES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0267000018 . This is a "STATE OF OHIO BOARD OF PHARMACY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4154785 . This is a "STATE OF OHIO CERTIFICATION SECRETARY OF STATE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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