Provider Demographics
NPI:1558300467
Name:OAK HOUSE
Entity Type:Organization
Organization Name:OAK HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KORMENDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-734-4417
Mailing Address - Street 1:333A BUCKEYE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1423
Mailing Address - Country:US
Mailing Address - Phone:419-734-4417
Mailing Address - Fax:419-734-4922
Practice Address - Street 1:333A BUCKEYE BLVD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1423
Practice Address - Country:US
Practice Address - Phone:419-734-4417
Practice Address - Fax:419-734-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0480320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness