Healthcare Provider Details

I. General information

NPI: 1275793028
Provider Name (Legal Business Name): BUCKEYE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 ARMANDALE AVE NW
CANTON OH
44718-2284
US

IV. Provider business mailing address

PO BOX 2779
ALLIANCE OH
44601-0779
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-9389
  • Fax: 330-829-9372
Mailing address:
  • Phone: 330-829-9389
  • Fax: 330-829-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35062816
License Number StateOH

VIII. Authorized Official

Name: RANGA R THALLURI
Title or Position: PSYCHIATRY
Credential: MD
Phone: 330-829-9389