Organization
KINDRED SPIRIT BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANIA S LODGE PHD (CLINICAL DIRECTOR)
(234) 466-0445
Entity
Organization
Contact information
Practice address
3618 W MARKET ST # E15, FAIRLAWN, OH 44333-2425
(234) 466-0445
Mailing address
PO BOX 4036, COPLEY, OH 44321-0036
(330) 271-6160
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0478831
—
OH
Enumeration date
03/11/2022
Last updated
09/22/2022
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