Provider Demographics
NPI:1851343735
Name:FAMILY RESOURCE CENTER OF NORTHWEST OHIO INC
Entity Type:Organization
Organization Name:FAMILY RESOURCE CENTER OF NORTHWEST OHIO INC
Other - Org Name:NORTHWEST FAMILY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BINDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:419-222-1168
Mailing Address - Street 1:530 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-1240
Mailing Address - Country:US
Mailing Address - Phone:419-222-1168
Mailing Address - Fax:419-222-7610
Practice Address - Street 1:530 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1240
Practice Address - Country:US
Practice Address - Phone:419-222-1168
Practice Address - Fax:419-222-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH056,6370,12606251B00000X, 261QM0801X, 261QM0855X
OH261QM0855X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864566Medicaid
OH2900981Medicaid
OH2900981Medicaid