Provider Demographics
NPI:1467919449
Name:NANCY BREWER MEMORIAL FOUNDATION
Entity Type:Organization
Organization Name:NANCY BREWER MEMORIAL FOUNDATION
Other - Org Name:FAMILY MATTERS OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:937-825-3223
Mailing Address - Street 1:1524 E STROOP RD STE 300
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5059
Mailing Address - Country:US
Mailing Address - Phone:937-541-0271
Mailing Address - Fax:
Practice Address - Street 1:1524 E STROOP RD STE 300
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5059
Practice Address - Country:US
Practice Address - Phone:937-541-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0180459Medicaid