Healthcare Provider Details

I. General information

NPI: 1871458000
Provider Name (Legal Business Name): KINDRED SPIRIT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 W MARKET ST
FAIRLAWN OH
44333-2425
US

IV. Provider business mailing address

3618 W MARKET ST
FAIRLAWN OH
44333-2425
US

V. Phone/Fax

Practice location:
  • Phone: 234-466-0445
  • Fax: 234-466-0359
Mailing address:
  • Phone: 234-466-0445
  • Fax: 234-466-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TANIA LODGE
Title or Position: CEO
Credential: PHD
Phone: 234-466-0445