Provider Demographics
NPI:1497806970
Name:SUBURBAN FAMILY SERVICES
Entity Type:Organization
Organization Name:SUBURBAN FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:IANNONE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:216-591-0322
Mailing Address - Street 1:23360 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5547
Mailing Address - Country:US
Mailing Address - Phone:216-591-0322
Mailing Address - Fax:216-360-7376
Practice Address - Street 1:23360 CHAGRIN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5547
Practice Address - Country:US
Practice Address - Phone:216-591-0322
Practice Address - Fax:216-360-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000165856OtherANTHEM BLUE CROSS & BLUE