| Family Pride Of Northeast Ohio Incorporated | |
|
695 South Street Suite 6 Chardon OH 44024 | |
| (440) 286-1553 | |
| (440) 286-1318 |
| Full Name | Family Pride Of Northeast Ohio Incorporated |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 695 South Street, Chardon, Ohio |
| Authorized Official Name and Position | Angela L. Daugherty (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4402861553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Pride Of Northeast Ohio Incorporated 695 South Street Suite 6 Chardon OH 44024 Ph: (440) 286-1553 | Family Pride Of Northeast Ohio Incorporated 695 South Street Suite 6 Chardon OH 44024 Ph: (440) 286-1553 |
| NPI Number | 1427013556 |
|---|---|
| Provider Enumeration Date | 04/20/2006 |
| Last Update Date | 04/02/2024 |
| Certification Date | 04/02/2024 |
| Medicare PECOS PAC ID | 9739458589 |
|---|---|
| Medicare Enrollment ID | O20170710003089 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427013556 | NPI | - | NPPES |
| 590 | Other | OH | OHIO DEPARTMENT OF MENTAL |
| Provider Name | Jane Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083908719 PECOS PAC ID: 4486937760 Enrollment ID: I20170210001813 |
| Provider Name | Rachel A Humphrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740698810 PECOS PAC ID: 0547531774 Enrollment ID: I20170807003175 |
| Provider Name | Angela L Daugherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770761926 PECOS PAC ID: 1557630308 Enrollment ID: I20170823001773 |
| Provider Name | Kelly J Bencivenni |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184087702 PECOS PAC ID: 9032488200 Enrollment ID: I20231205002886 |
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