MEDICARE: KINDRED SPIRIT BEHAVIORAL HEALTH

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1871458000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDRED SPIRIT BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	3618 W MARKET ST # E15
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2425
Country	:	US
Telephone Number	:	234-466-0445
Fax Number	:	234-466-0359

Provider Business Practice Location Address
First Line	:	3618 W MARKET ST # E15
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2425
Country	:	US
Telephone Number	:	234-466-0445
Fax Number	:	234-466-0359

Authorized Official
Title or Position	:	CEO
Name	:	TANIA LODGE
Credential	:	PHD
Telephone Number	:	234-466-0445

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	01/20/2026

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