Organization
STATE OF OHIO DEPARTMENT OF MENTAL HEALTH
Active
Other names
TV - New Dimensions CSN
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONYA MARIE FASONE (FISCAL MANAGER)
(614) 466-9930
Entity
Organization
Contact information
Practice address
2611 WAYNE AVE, BLDG #66, DAYTON, OH 45420-1833
(937) 258-0440
(937) 258-6218
Mailing address
30 E. BROAD ST, 11TH FLOOR - FISCAL ADMINISTRATION, COLUMBUS, OH 43215-3430
(614) 466-6583
(614) 466-5331
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10019
MACSIS
OH
05
—
2444019
—
OH
Enumeration date
03/15/2006
Last updated
01/29/2008
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