Provider Demographics
NPI:1427013556
Name:FAMILY PRIDE OF NORTHEAST OHIO INCORPORATED
Entity Type:Organization
Organization Name:FAMILY PRIDE OF NORTHEAST OHIO INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:440-286-1553
Mailing Address - Street 1:695 SOUTH STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-286-1553
Mailing Address - Fax:440-286-1318
Practice Address - Street 1:695 SOUTH STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-286-1553
Practice Address - Fax:440-286-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0044561041C0700X
OH1041C0700X
OH010590251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590OtherOHIO DEPARTMENT OF MENTAL