Provider Demographics
NPI:1528563079
Name:COMMUNITY TEACHING HOMES, INC.
Entity Type:Organization
Organization Name:COMMUNITY TEACHING HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-868-1178
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-0400
Mailing Address - Country:US
Mailing Address - Phone:419-868-1178
Mailing Address - Fax:419-868-1989
Practice Address - Street 1:6715 DORR ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-4207
Practice Address - Country:US
Practice Address - Phone:419-868-1178
Practice Address - Fax:419-868-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01-0618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247395Medicaid