Provider Demographics
NPI:1902099989
Name:FAMILY SERVICE OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:FAMILY SERVICE OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:800-693-6000
Mailing Address - Street 1:1 STRANAHAN SQ
Mailing Address - Street 2:SUITE 414
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1447
Mailing Address - Country:US
Mailing Address - Phone:419-244-5511
Mailing Address - Fax:419-321-6459
Practice Address - Street 1:228 S MAIN ST
Practice Address - Street 2:FOUR COUNTY FAMILY CENTER
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1755
Practice Address - Country:US
Practice Address - Phone:800-593-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0009991251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPRSW39061Medicare Oscar/Certification