Basic Information
| Provider Information | |||||||||
| NPI: | 1699037531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AKRON COMMUNITY DEVELOPMENT ASSOCIATION INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MINORITY BEHAVIORAL HEALTH GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1293 COPLEY RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443202766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303741199 | ||||||||
| FaxNumber: | 3303740151 | ||||||||
| Practice Location | |||||||||
| Address1: | 1293 COPLEY RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443202766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303741199 | ||||||||
| FaxNumber: | 3303740151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2012 | ||||||||
| LastUpdateDate: | 08/06/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DENNIS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3303741199 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 251S00000X | 0661 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 3112518 | 05 | OH | MEDICAID |