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NPI Code Detail

MEDICARE: CRISIS INTERVENTION AND RECOVERY CENTER, INC.

MEDICARE: CRISIS INTERVENTION AND RECOVERY CENTER, INC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1251V00000XVoluntary or Charitable Agency0203OH

Other Identifiers

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

General Provider Information

NPI Number : 1831162817
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRISIS INTERVENTION AND RECOVERY CENTER, INC.
Provider Business Mailing Address
First Line : 832 MCKINLEY AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44703-2463
Country : US
Telephone Number : 330-452-9812
Fax Number :
Provider Business Practice Location Address
First Line : 832 MCKINLEY AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44703-2463
Country : US
Telephone Number : 330-452-9812
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. BERNARD JESIOLOWSKI
Credential : PHD.
Telephone Number : 330-452-9812
Provider Enumeration Date : 02/09/2006
Last Update Date : 02/27/2012

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Directions to “CRISIS INTERVENTION AND RECOVERY CENTER, INC. ” Practice Location

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