Provider Demographics
NPI:1093278699
Name:GLASS CITY BEHAVIORAL HEALTHCARE INC
Entity Type:Organization
Organization Name:GLASS CITY BEHAVIORAL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:SHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-503-4568
Mailing Address - Street 1:18600 RED HAWK CT
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9433
Mailing Address - Country:US
Mailing Address - Phone:419-503-4568
Mailing Address - Fax:
Practice Address - Street 1:5151 MONROE ST STE 244
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3461
Practice Address - Country:US
Practice Address - Phone:419-957-1863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management