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NPI Code Detail

MEDICARE: PORTAGE PATH BEHAVIORAL HEALTH

MEDICARE: PORTAGE PATH 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1881643633
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORTAGE PATH BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 340 S BROADWAY ST
Second Line :
City : AKRON
State : OH
Zip : 44308-1529
Country : US
Telephone Number : 330-253-3100
Fax Number : 330-253-5248
Provider Business Practice Location Address
First Line : 10 PENFIELD AVE
Second Line :
City : AKRON
State : OH
Zip : 44310-2912
Country : US
Telephone Number : 330-762-6110
Fax Number : 330-253-5248
Authorized Official
Title or Position : PRESIDENT
Name : MR. JERRY T KRAKER
Credential :
Telephone Number : 330-253-3100
Provider Enumeration Date : 05/09/2006
Last Update Date : 08/22/2020

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Directions to “PORTAGE PATH BEHAVIORAL HEALTH ” Practice Location

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