Healthcare Provider Details

I. General information

NPI: 1982259693
Provider Name (Legal Business Name): FAMILY GUIDANCE CENTERS OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 MONROE ST
TOLEDO OH
43606-1959
US

IV. Provider business mailing address

2618 PATRIOT BLVD
GLENVIEW IL
60026-8024
US

V. Phone/Fax

Practice location:
  • Phone: 419-442-7145
  • Fax: 419-389-0306
Mailing address:
  • Phone: 224-659-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMY IDE
Title or Position: MANAGED CARE SPECIALIST
Credential:
Phone: 224-659-7030