Provider Demographics
NPI:1063262376
Name:LIVE UP BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:LIVE UP BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-224-0708
Mailing Address - Street 1:51B E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857
Mailing Address - Country:US
Mailing Address - Phone:567-224-0708
Mailing Address - Fax:
Practice Address - Street 1:51B E MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1514
Practice Address - Country:US
Practice Address - Phone:567-224-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No253Z00000XAgenciesIn Home Supportive Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty