Provider Demographics
NPI:1730847161
Name:FATHERS AND SONS OF NORTHEAST OHIO INC
Entity type:Organization
Organization Name:FATHERS AND SONS OF NORTHEAST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRAE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:216-287-5031
Mailing Address - Street 1:1382 HART ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1855
Mailing Address - Country:US
Mailing Address - Phone:330-548-2319
Mailing Address - Fax:
Practice Address - Street 1:213 GLENWOOD AVE.
Practice Address - Street 2:ROOM # 214
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-548-2319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty