Healthcare Provider Details

I. General information

NPI: 1902099989
Provider Name (Legal Business Name): FAMILY SERVICE OF NORTHWEST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S MAIN ST FOUR COUNTY FAMILY CENTER
BRYAN OH
43506-1755
US

IV. Provider business mailing address

1 STRANAHAN SQ SUITE 414
TOLEDO OH
43604-1447
US

V. Phone/Fax

Practice location:
  • Phone: 800-593-6000
  • Fax:
Mailing address:
  • Phone: 419-244-5511
  • Fax: 419-321-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberI0009991
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberI0009991
License Number StateOH

VIII. Authorized Official

Name: MS. KATHY SHORT
Title or Position: DIRECTOR
Credential: MSW
Phone: 800-693-6000