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NPI Code Detail

MEDICARE: FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.

MEDICARE: FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)0200893OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336118330
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 4761 STATE ROUTE 29
Second Line :
City : CELINA
State : OH
Zip : 45822-8216
Country : US
Telephone Number : 419-584-1000
Fax Number : 419-584-1825
Provider Business Practice Location Address
First Line : 4761 STATE ROUTE 29
Second Line :
City : CELINA
State : OH
Zip : 45822-8216
Country : US
Telephone Number : 419-584-1000
Fax Number : 419-584-1825
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DIANE GABLE
Credential : LISW
Telephone Number : 419-584-1000
Provider Enumeration Date : 03/14/2006
Last Update Date : 12/14/2020

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Directions to “FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC. ” Practice Location

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