| Huber Heights Holdings, Llc | |
|
6210 Bellefontaine Rd Huber Heights OH 45424-4009 | |
| (937) 236-1800 | |
| (937) 701-6910 |
| Full Name | Huber Heights Holdings, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6210 Bellefontaine Rd, Huber Heights, Ohio |
| Authorized Official Name and Position | Rachel E Costello (CEO) |
| Authorized Official Contact | 9372361800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Huber Heights Holdings, Llc 6210 Bellefontaine Rd Huber Heights OH 45424-4009 Ph: (937) 236-1800 | Huber Heights Holdings, Llc 6210 Bellefontaine Rd Huber Heights OH 45424-4009 Ph: (937) 236-1800 |
| NPI Number | 1235980293 |
|---|---|
| Provider Enumeration Date | 03/28/2024 |
| Last Update Date | 03/28/2024 |
| Certification Date | 03/28/2024 |
| Medicare PECOS PAC ID | 3173971264 |
|---|---|
| Medicare Enrollment ID | O20240713000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235980293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Amarjeet S Birdi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023046190 PECOS PAC ID: 5799819777 Enrollment ID: I20100812000356 |
| Provider Name | Angelic Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588294243 PECOS PAC ID: 2163844085 Enrollment ID: I20200623002607 |
| Provider Name | Rebecca J Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346594124 PECOS PAC ID: 0143631051 Enrollment ID: I20201125001744 |
| Provider Name | Cindy Opoku-antwi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720759111 PECOS PAC ID: 9638568892 Enrollment ID: I20211110001627 |
| Provider Name | Antoinette Tegtmeier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164055794 PECOS PAC ID: 6204298011 Enrollment ID: I20230810002588 |
| Provider Name | Rachel E Costello |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396208492 PECOS PAC ID: 3678726437 Enrollment ID: I20240325002423 |
| Provider Name | Kahlin A Kelly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083020259 PECOS PAC ID: 9830639665 Enrollment ID: I20240909000401 |
| Provider Name | Trevor Shelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417785841 PECOS PAC ID: 5991246050 Enrollment ID: I20240917003632 |
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