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1200 Ralston Ave Defiance OH 43512-1396 | |
| (800) 477-4035 | |
| (419) 882-1352 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1200 Ralston Ave, Defiance, Ohio |
| Authorized Official Name and Position | Kevin Sharp (VP REV CYCLE) |
| Authorized Official Contact | 5675857576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 632927 Cincinnati OH 45263-2927 Ph: (800) 477-4035 | 1200 Ralston Ave Defiance OH 43512-1396 Ph: (800) 477-4035 |
| NPI Number | 1598765000 |
|---|---|
| Provider Enumeration Date | 07/26/2005 |
| Last Update Date | 12/22/2023 |
| Certification Date | 12/22/2023 |
| Medicare PECOS PAC ID | 6305754557 |
|---|---|
| Medicare Enrollment ID | O20090922000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598765000 | NPI | - | NPPES |
| 2079503 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 1160 (Ohio) | Primary |
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