=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871458000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINDRED SPIRIT BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3618 W MARKET ST
-----------------------------------------------------
City | FAIRLAWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-466-0445
-----------------------------------------------------
Fax | 234-466-0359
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3618 W MARKET ST
-----------------------------------------------------
City | FAIRLAWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 234-466-0445
-----------------------------------------------------
Fax | 234-466-0359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TANIA LODGE
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 234-466-0445
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------