Provider Demographics
NPI:1891858999
Name:NORTHEAST OHIO BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:NORTHEAST OHIO BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TENER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-945-7100
Mailing Address - Street 1:2795 FRONT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1900
Mailing Address - Country:US
Mailing Address - Phone:330-945-7100
Mailing Address - Fax:330-945-4305
Practice Address - Street 1:2795 FRONT ST
Practice Address - Street 2:SUITE A
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1900
Practice Address - Country:US
Practice Address - Phone:330-945-7100
Practice Address - Fax:330-945-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10034Medicaid
OH10024Medicaid