MEDICARE: CAREGIVER GROVE BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801323928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREGIVER GROVE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	3950 SUNFOREST CT STE 207
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4522
Country	:	US
Telephone Number	:	419-720-6811
Fax Number	:	419-754-2271

Provider Business Practice Location Address
First Line	:	3950 SUNFOREST CT STE 207
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-4522
Country	:	US
Telephone Number	:	419-720-6811
Fax Number	:	419-754-2271

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	CHASS RICE
Credential	:
Telephone Number	:	419-340-5137

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	05/16/2024

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