Healthcare Provider Details

I. General information

NPI: 1568722171
Provider Name (Legal Business Name): THE CENTER FOR INDIVIDUAL & FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 SCHOLL RD
MANSFIELD OH
44907-1571
US

IV. Provider business mailing address

741 SCHOLL RD
MANSFIELD OH
44907-1571
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-1717
  • Fax: 419-774-5955
Mailing address:
  • Phone: 419-756-1717
  • Fax: 419-774-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number04158
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number13000
License Number StateOH

VIII. Authorized Official

Name: LAURA MONTGOMERY
Title or Position: CEO
Credential:
Phone: 419-774-6705