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General NPI Number Information
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NPI Number | 1134452576
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Entity Type | Organization
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Legal Business Name | FORENSIC PSYCHIATRIC CENTER OF NORTHEAST OHIO, INC
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 5212 MAHONING AVE SUITE 317
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-1857
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Country | US
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Telephone | 330-792-1918
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Fax | 330-792-7712
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Provider Business Mailing Address
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Address Line | 5212 MAHONING AVE SUITE 317
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City | YOUNGSTOWN
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State | OH
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Zip | 44515-1857
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Country | US
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Telephone | 330-792-1918
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Fax | 330-792-7712
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GERALD L HEINBAUGH
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Credential | MS, MBA
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Telephone | 330-792-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 295
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 295
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License Number State | OH
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