Provider Demographics
NPI:1659445153
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:2006-11-17
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0574061Medicaid
OH4618OtherOHIO MACSIS MEDICAID
OH0959566Medicaid
OH0959566Medicaid