NPIMap

Organization Active NPI

Mohican Youth Academy

  • Neurodevelopmental Disabilities Physician
  • Perrysville, OH
National Provider Identifier
1063926616
Registry record updated Nov 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurodevelopmental Disabilities PhysicianTaxonomy code 2084P0005X
Legal business name
MOHICAN YOUTH ACADEMY
Practice address
1012 Odnr Mohican 51
Perrysville, OH 44864-9407
Phone
(419) 994-0300
NPI assigned
Nov 18, 2017
Last updated
Nov 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2017

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

Authorized official

Name
Wendy Bruno
Title
Credentialing
Phone
(614) 556-4616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurodevelopmental Disabilities Physician 2084P0005X Primary

Addresses

Primary practice location

1012 Odnr Mohican 51
Perrysville, OH 44864-9407

Mailing address

1012 Odnr Mohican 51
Perrysville, OH 44864-9407
Phone (419) 994-0300

National Provider Directory

National Provider Directory
Tax ID family
Mohican Youth Academy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1510963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510963200000",
    "number": "1063926616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1012 ODNR MOHICAN 51",
            "city": "PERRYSVILLE",
            "state": "OH",
            "postal_code": "448649407",
            "telephone_number": "419-994-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 ODNR MOHICAN 51",
            "city": "PERRYSVILLE",
            "state": "OH",
            "postal_code": "448649407",
            "telephone_number": "419-994-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHICAN YOUTH ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-18",
        "last_updated": "2017-11-18",
        "status": "A",
        "authorized_official_last_name": "BRUNO",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "614-556-4616"
    },
    "taxonomies": [
        {
            "code": "2084P0005X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2017; 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.