Provider Demographics
NPI:1902306954
Name:50 NORTH
Entity Type:Organization
Organization Name:50 NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-423-8496
Mailing Address - Street 1:339 E MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4408
Mailing Address - Country:US
Mailing Address - Phone:419-423-8496
Mailing Address - Fax:419-423-4980
Practice Address - Street 1:339 E MELROSE AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4408
Practice Address - Country:US
Practice Address - Phone:419-423-8496
Practice Address - Fax:419-423-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherPROVIDER SUPPLIER
=========OtherSUPPLIER