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General NPI Number Information
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NPI Number | 1184693269
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Entity Type | Organization
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Legal Business Name | STATE OF OHIO DEPARTMENT OF MENTAL HEALTH
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 2321 SECOND ST SUITE 102
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City | CUYAHOGA FALLS
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State | OH
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Zip | 44221-2520
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Country | US
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Telephone | 330-833-3135
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Fax | 330-833-9216
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Provider Business Mailing Address
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Address Line | 30 E. BROAD ST 11TH FLOOR - FISCAL ADMINISTRATION
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City | COLUMBUS
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State | OH
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Zip | 43215-3430
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Country | US
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Telephone | 614-466-6583
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Fax | 614-644-5331
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Authorized Official
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Title or Position | FISCAL MANAGER
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Name | MS. TONYA MARIE FASONE
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Credential |
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Telephone | 614-466-9930
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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 |
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License Number State | OH
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