Provider Demographics
NPI:1336118330
Name:FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:FOUNDATIONS BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-584-1000
Mailing Address - Street 1:4761 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-8216
Mailing Address - Country:US
Mailing Address - Phone:419-584-1000
Mailing Address - Fax:419-584-1825
Practice Address - Street 1:4761 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-8216
Practice Address - Country:US
Practice Address - Phone:419-584-1000
Practice Address - Fax:419-584-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0200893261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200893Medicaid
OH0200893Medicaid