Provider Demographics
NPI:1275683690
Name:EMERGE MINISTRIES, INC
Entity Type:Organization
Organization Name:EMERGE MINISTRIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEIDBREDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-867-5603
Mailing Address - Street 1:900 MULL AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7502
Mailing Address - Country:US
Mailing Address - Phone:330-867-5603
Mailing Address - Fax:330-873-3439
Practice Address - Street 1:900 MULL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7502
Practice Address - Country:US
Practice Address - Phone:330-867-5603
Practice Address - Fax:330-873-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003876251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH543777OtherVALUE OPTIONS
OH286605356001OtherMEDICAL MUTUAL
OH000000320605OtherANTHEM BCBS
OH6289137OtherUNITED BEHAVIORAL HUH
OH733558000OtherMAGELLAN
OH2375451Medicaid
OH2375451Medicaid