Provider Demographics
NPI:1720341175
Name:OHIOGUIDESTONE
Entity type:Organization
Organization Name:OHIOGUIDESTONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRES, CHIEF CLINICAL OFFICER
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:440-260-8300
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:440-260-8327
Mailing Address - Fax:440-234-8319
Practice Address - Street 1:25701 N LAKELAND BLVD
Practice Address - Street 2:#403
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2450
Practice Address - Country:US
Practice Address - Phone:440-260-6122
Practice Address - Fax:216-731-8335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health