Provider Demographics
NPI:1568539690
Name:THE EPILEPSY CENTER OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:THE EPILEPSY CENTER OF NORTHWEST OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-867-5950
Mailing Address - Street 1:1701 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1699
Mailing Address - Country:US
Mailing Address - Phone:419-867-5950
Mailing Address - Fax:419-867-5954
Practice Address - Street 1:1701 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1699
Practice Address - Country:US
Practice Address - Phone:419-867-5950
Practice Address - Fax:419-867-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4800451320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities