Provider Demographics
NPI:1033571963
Name:MANSFIELD URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Entity Type:Organization
Organization Name:MANSFIELD URBAN MINORITY ALCOHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Other - Org Name:MANSFIELD UMADAOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-525-3525
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44901-1316
Mailing Address - Country:US
Mailing Address - Phone:419-525-3525
Mailing Address - Fax:419-525-3538
Practice Address - Street 1:400 BOWMAN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1235
Practice Address - Country:US
Practice Address - Phone:419-525-3525
Practice Address - Fax:419-525-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health