Provider Demographics
NPI:1821577131
Name:CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CHILD AND ADOLESCENT BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-454-7917
Mailing Address - Street 1:919 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1132
Mailing Address - Country:US
Mailing Address - Phone:330-454-7917
Mailing Address - Fax:330-452-8860
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:330-452-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846844Medicaid