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General NPI Number Information
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NPI Number | 1972747566
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MENTAL HEALTH INC
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 65 N LAKE ST SUITE 100
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City | MADISON
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State | OH
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Zip | 44057-3113
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Country | US
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Telephone | 440-428-0055
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Fax | 440-428-0084
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Provider Business Mailing Address
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Address Line | 65 N LAKE ST SUITE 100
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City | MADISON
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State | OH
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Zip | 44057-3113
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Country | US
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Telephone | 440-428-0055
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Fax | 440-428-0084
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Authorized Official
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Title or Position | BILLING SERVICES
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Name | SARBJOT SINGH AJIT
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Credential | M.D.
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Telephone | 440-428-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35087896
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License Number State | OH
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