Provider Demographics
NPI:1740451756
Name:PSYCHOLOGICAL HEALTH CENTER & ALCOHOLISM TREATMENT PROGRAM, INC.
Entity type:Organization
Organization Name:PSYCHOLOGICAL HEALTH CENTER & ALCOHOLISM TREATMENT PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINTAUTAS
Authorized Official - Middle Name:Z
Authorized Official - Last Name:SABATAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-845-9061
Mailing Address - Street 1:6315 PEARL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3074
Mailing Address - Country:US
Mailing Address - Phone:440-845-9061
Mailing Address - Fax:440-845-9062
Practice Address - Street 1:6315 PEARL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3074
Practice Address - Country:US
Practice Address - Phone:440-845-9061
Practice Address - Fax:440-845-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1436305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1093784811OtherINDIVIDUAL NPI
OH0251561Medicaid
OH9265601Medicare UPIN
OH05051Medicare PIN