Provider Demographics
NPI:1801323928
Name:CAREGIVER GROVE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CAREGIVER GROVE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHASS
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-340-5137
Mailing Address - Street 1:3950 SUNFOREST CT STE 207
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4522
Mailing Address - Country:US
Mailing Address - Phone:419-720-6811
Mailing Address - Fax:419-754-2271
Practice Address - Street 1:3950 SUNFOREST CT STE 207
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4522
Practice Address - Country:US
Practice Address - Phone:419-720-6811
Practice Address - Fax:419-754-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-19
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223685Medicaid
OH=========Medicaid