Provider Demographics
NPI:1932418779
Name:INDEPENDENCE OF PORTAGE COUNTY, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE OF PORTAGE COUNTY, INC.
Other - Org Name:PATHS TO INDEPENDENCE - CLEVELAND
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-296-2851
Mailing Address - Street 1:161 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3129
Mailing Address - Country:US
Mailing Address - Phone:330-296-2851
Mailing Address - Fax:330-296-8631
Practice Address - Street 1:837 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2023
Practice Address - Country:US
Practice Address - Phone:330-296-2851
Practice Address - Fax:330-296-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGOtherPENDING