Provider Demographics
NPI:1265612162
Name:THE PACKARD INSTITUTE, INC.
Entity type:Organization
Organization Name:THE PACKARD INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MAED, LICDC
Authorized Official - Phone:330-762-4357
Mailing Address - Street 1:733 W MARKET ST STE B4
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1084
Mailing Address - Country:US
Mailing Address - Phone:330-762-4357
Mailing Address - Fax:
Practice Address - Street 1:733 W MARKET ST STE B4
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1084
Practice Address - Country:US
Practice Address - Phone:330-762-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976205251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health