Provider Demographics
NPI:1982259693
Name:FAMILY GUIDANCE CENTERS OF OHIO, INC.
Entity Type:Organization
Organization Name:FAMILY GUIDANCE CENTERS OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:IDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-659-7030
Mailing Address - Street 1:2618 PATRIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8024
Mailing Address - Country:US
Mailing Address - Phone:224-659-7030
Mailing Address - Fax:
Practice Address - Street 1:4354 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1959
Practice Address - Country:US
Practice Address - Phone:419-442-7145
Practice Address - Fax:419-389-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-7760OtherOHIO MENTAL HEALTH & ADDICTION SERVICES
OH0267000018OtherSTATE OF OHIO BOARD OF PHARMACY
OH4154785OtherSTATE OF OHIO CERTIFICATION SECRETARY OF STATE