Provider Demographics
NPI:1699037531
Name:AKRON COMMUNITY DEVELOPMENT ASSOCIATION INC
Entity Type:Organization
Organization Name:AKRON COMMUNITY DEVELOPMENT ASSOCIATION INC
Other - Org Name:MINORITY BEHAVIORAL HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-374-1199
Mailing Address - Street 1:1293 COPLEY RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2766
Mailing Address - Country:US
Mailing Address - Phone:330-374-1199
Mailing Address - Fax:330-374-0151
Practice Address - Street 1:1293 COPLEY RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-2766
Practice Address - Country:US
Practice Address - Phone:330-374-1199
Practice Address - Fax:330-374-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0661251S00000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3112518Medicaid