Provider Demographics
NPI:1093771230
Name:FAR WEST CENTER
Entity Type:Organization
Organization Name:FAR WEST CENTER
Other - Org Name:MAIN LOCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DYLAG
Authorized Official - Suffix:
Authorized Official - Credentials:RN, APRN
Authorized Official - Phone:440-835-6212
Mailing Address - Street 1:29133 HEALTH CAMPUS DR
Mailing Address - Street 2:BLDG. 4
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5256
Mailing Address - Country:US
Mailing Address - Phone:440-835-6212
Mailing Address - Fax:440-835-6231
Practice Address - Street 1:29133 HEALTH CAMPUS DR
Practice Address - Street 2:BLDG. 4
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5256
Practice Address - Country:US
Practice Address - Phone:440-835-6212
Practice Address - Fax:440-835-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QM0850X
OH209261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10460OtherLORAIN COUNTY BOARD OF MENTAL HEALTH
OH02505OtherADAMHS BOARD OF CUYAHOGA COUNTY
OH0959548Medicaid