Healthcare Provider Details

I. General information

NPI: 1295074821
Provider Name (Legal Business Name): THE CENTER FOR INDIVIDUAL AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 STERKEL BLVD 270 STERKEL BLVD
MANSFIELD OH
44907-1508
US

IV. Provider business mailing address

270 STERKEL BLVD
MANSFIELD OH
44907-1508
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-1133
  • Fax:
Mailing address:
  • Phone: 419-756-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS1200452
License Number StateOH

VIII. Authorized Official

Name: LAURA MONTGOMERY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 419-774-6884