Provider Demographics
NPI:1528192655
Name:JEWISH FAMILY SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:JEWISH FAMILY SERVICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO / V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HLAVAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-504-6408
Mailing Address - Street 1:29125 CHAGRIN BLVD.
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4622
Mailing Address - Country:US
Mailing Address - Phone:216-504-6476
Mailing Address - Fax:216-916-9147
Practice Address - Street 1:29125 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44122-4622
Practice Address - Country:US
Practice Address - Phone:216-292-3999
Practice Address - Fax:216-916-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 225100000X, 225X00000X
OH367770251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2230544Medicaid
OH367770Medicare ID - Type Unspecified