Organization
YORK AVENUE CHURCH OF GOD TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHNNY GRAHAM LICDC (EXECUTIVE DIRECTOR)
(330) 392-4199
Entity
Organization
Contact information
Practice address
1228 W MARKET ST, WARREN, OH 44485-2780
(330) 392-4199
(330) 392-4904
Mailing address
1228 W MARKET ST, WARREN, OH 44485-2780
(330) 392-4199
(330) 392-4904
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
6949
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06949
UCI NUMBER
OH
Enumeration date
02/16/2006
Last updated
08/22/2020
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