MEDICARE: CHILD AND ADOLESCENT BEHAVIORAL HEALTH

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251V00000X	Voluntary or Charitable Agency
3	251S00000X	Community/Behavioral Health Agency

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

NPI Number	:	1831172576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD AND ADOLESCENT BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	4641 FULTON DR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2384
Country	:	US
Telephone Number	:	330-433-6075
Fax Number	:	330-494-0299

Provider Business Practice Location Address
First Line	:	4641 FULTON DR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2384
Country	:	US
Telephone Number	:	330-433-6075
Fax Number	:	330-494-0299

Authorized Official
Title or Position	:	HR ADMIN ASSISTANT/CREDENTIALING
Name	:	COURTNEY SHAHAN
Credential	:
Telephone Number	:	330-433-6075

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	08/21/2025

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax: