Provider Demographics
NPI:1952370561
Name:UNISON BEHAVIORAL HEALTH GROUP, INC.
Entity Type:Organization
Organization Name:UNISON BEHAVIORAL HEALTH GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE COORDINATOR/CREDENTIA
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-693-0631
Mailing Address - Street 1:1425 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2456
Mailing Address - Country:US
Mailing Address - Phone:419-693-0631
Mailing Address - Fax:419-936-7606
Practice Address - Street 1:1425 STARR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2456
Practice Address - Country:US
Practice Address - Phone:419-693-0631
Practice Address - Fax:419-936-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0231251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482013Medicaid
OH0201641Medicaid
OH2482013Medicaid
OH9281602Medicare PIN