NPIMap

Organization Active NPI

State of Ohio Office of Budget and Management, State Accounting

Doing business as NB - Lake Residential Support CSN

  • Mental Illness Community Based Residential Treatment Facility
  • Willoughby, OH
National Provider Identifier
1013986082
Registry record updated Nov 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT, STATE ACCOUNTING
Doing business as
NB - Lake Residential Support CSN
Practice address
1420 Lost Nation Rd
Willoughby, OH 44094-7375
Phone
(330) 467-7131
Fax
(330) 467-2420
NPI assigned
Mar 14, 2006
Last updated
Nov 30, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Tonya Marie Fasone
Title
Fiscal Manager
Phone
(614) 466-9930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X OH Primary

Addresses

Primary practice location

1420 Lost Nation Rd
Willoughby, OH 44094-7375

Mailing address

30 E. Broad St
11TH Floor - Fiscal Administration
Columbus, OH 43215-3430
Phone (614) 466-6583

Other identifiers 1

IdentifierTypeStateIssuer
10409OtherOHMACSIS

Other names 1

  • NB - Lake Residential Support CSN Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Central Ohio Pyschiatri39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1013986082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E. BROAD ST",
            "address_2": "11TH FLOOR - FISCAL ADMINISTRATION",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432153430",
            "telephone_number": "614-466-6583",
            "fax_number": "614-644-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 LOST NATION RD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947375",
            "telephone_number": "330-467-7131",
            "fax_number": "330-467-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT, STATE ACCOUNTING",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-14",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "FASONE",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "FISCAL MANAGER",
        "authorized_official_telephone_number": "614-466-9930",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "OH",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MACSIS",
            "identifier": "10409",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NB - Lake Residential Support CSN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.