Provider Demographics
NPI:1073293569
Name:MONARCH GRIEF CENTER
Entity Type:Organization
Organization Name:MONARCH GRIEF CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LMSW
Authorized Official - Phone:567-331-8601
Mailing Address - Street 1:314 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1461
Mailing Address - Country:US
Mailing Address - Phone:567-331-8601
Mailing Address - Fax:
Practice Address - Street 1:314 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1461
Practice Address - Country:US
Practice Address - Phone:567-331-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health