Provider Demographics
NPI:1588935779
Name:OHIOGUIDESTONE
Entity type:Organization
Organization Name:OHIOGUIDESTONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, COUNSELING
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:440-260-8340
Mailing Address - Street 1:434 EASTLAND RD.
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2058
Mailing Address - Country:US
Mailing Address - Phone:440-260-8300
Mailing Address - Fax:440-234-8319
Practice Address - Street 1:303 E BAGLEY RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2040
Practice Address - Country:US
Practice Address - Phone:440-260-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004854305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization