Provider Demographics
NPI:1902829880
Name:CENTRAL BEHAVIORAL HEALTHCARE INC
Entity Type:Organization
Organization Name:CENTRAL BEHAVIORAL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KOGUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-882-5678
Mailing Address - Street 1:5965 RENAISSANCE PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4709
Mailing Address - Country:US
Mailing Address - Phone:419-882-5678
Mailing Address - Fax:
Practice Address - Street 1:5965 RENAISSANCE PL
Practice Address - Street 2:SUITE 1
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4709
Practice Address - Country:US
Practice Address - Phone:419-882-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO2553Medicare PIN