NPIMap

Organization Active NPI

Monarch Grief Center

  • Community/Behavioral Health Agency
  • Perrysburg, OH
National Provider Identifier
1073293569
Registry record updated Jul 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MONARCH GRIEF CENTER
Practice address
314 Louisiana Ave
Perrysburg, OH 43551-1461
Phone
(567) 331-8601
NPI assigned
Jul 20, 2023
Last updated
Jul 20, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2023

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

Authorized official

Name
Timothy Polakowski, LISW-S, LMSWNPI 1871273276
Title
Cofounder & Executive Director
Phone
(567) 331-8601

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

314 Louisiana Ave
Perrysburg, OH 43551-1461

Mailing address

314 Louisiana Ave
Perrysburg, OH 43551-1461
Phone (567) 331-8601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230913002160 OH Part B Supplier - Clinic/Group Practice 1254795909 Receives reassigned benefits from 5 practitioners
Practice locations: Perrysburg, OH

National Provider Directory

National Provider Directory

Locations

314 Louisiana Ave
Perrysburg, OH 43551
Phone (567) 331-8601

Practitioners & affiliated clinicians

Practitioners 11

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": "1689811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689811200000",
    "number": "1073293569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 LOUISIANA AVE",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511461",
            "telephone_number": "567-331-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 LOUISIANA AVE",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435511461",
            "telephone_number": "567-331-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONARCH GRIEF CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-20",
        "last_updated": "2023-07-20",
        "certification_date": "2023-07-20",
        "status": "A",
        "authorized_official_last_name": "POLAKOWSKI",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "COFOUNDER & EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "567-331-8601",
        "authorized_official_credential": "LISW-S, LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.