Provider Demographics
NPI:1083688097
Name:STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
Entity Type:Organization
Organization Name:STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
Other - Org Name:NORTHWEST OHIO PYSCHIATRIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-452-4343
Mailing Address - Street 1:30 E BROAD ST
Mailing Address - Street 2:11TH FL, ATTN:BETTY TAYLOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3414
Mailing Address - Country:US
Mailing Address - Phone:614-728-2546
Mailing Address - Fax:614-644-9116
Practice Address - Street 1:930 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2701
Practice Address - Country:US
Practice Address - Phone:419-381-1881
Practice Address - Fax:419-389-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150321Medicaid
OH364014Medicare UPIN
OH0150321Medicaid