Healthcare Provider Details

I. General information

NPI: 1639468127
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JAVIT CT
AUSTINTOWN OH
44515-2439
US

IV. Provider business mailing address

104 JAVIT CT
AUSTINTOWN OH
44515-2439
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-4050
  • Fax: 330-797-4090
Mailing address:
  • Phone: 330-797-4050
  • Fax: 330-797-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number35042814
License Number StateOH

VIII. Authorized Official

Name: SASI KAZA
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-797-4050