Provider Demographics
NPI:1922425180
Name:A RENEWED MIND
Entity Type:Organization
Organization Name:A RENEWED MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL INTERVENTION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-720-9247
Mailing Address - Street 1:1946 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7258
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:
Practice Address - Street 1:1946 N 13TH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7258
Practice Address - Country:US
Practice Address - Phone:419-720-9247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2963990Medicaid