Provider Demographics
NPI:1194464081
Name:HUBER HEIGHTS HOLDINGS, LLC
Entity Type:Organization
Organization Name:HUBER HEIGHTS HOLDINGS, LLC
Other - Org Name:AM BEHAVIORAL HUBER HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-442-2643
Mailing Address - Street 1:28059 US HIGHWAY 19 N STE 205
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2620
Mailing Address - Country:US
Mailing Address - Phone:352-442-2643
Mailing Address - Fax:
Practice Address - Street 1:6210 BELLEFONTAINE RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-4009
Practice Address - Country:US
Practice Address - Phone:937-236-1800
Practice Address - Fax:937-347-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital