Provider Demographics
NPI:1821059916
Name:FAMILY SERVICE OF NORTHWEST OHIO
Entity Type:Organization
Organization Name:FAMILY SERVICE OF NORTHWEST OHIO
Other - Org Name:FOUR COUNTY FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:419-244-5511
Mailing Address - Street 1:701 JEFFERSON
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:419-244-5511
Mailing Address - Fax:419-321-6459
Practice Address - Street 1:7320 STATE HIGHWAY 108
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8201
Practice Address - Country:US
Practice Address - Phone:419-335-3732
Practice Address - Fax:419-335-3462
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICE OF NW OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0180261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10149Medicare UPIN
OHFA9283211Medicare ID - Type Unspecified