Provider Demographics
NPI:1184678500
Name:THE MAIN PLACE, INC.
Entity type:Organization
Organization Name:THE MAIN PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-345-6874
Mailing Address - Street 1:33 W MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5547
Mailing Address - Country:US
Mailing Address - Phone:740-345-6874
Mailing Address - Fax:740-345-5157
Practice Address - Street 1:112 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5335
Practice Address - Country:US
Practice Address - Phone:740-345-6246
Practice Address - Fax:740-345-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH456Medicaid
OH456Medicaid