York Avenue Church of God Treatment Center

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

6949 Issued in OH

Legal business name

YORK AVENUE CHURCH OF GOD TREATMENT CENTER

Practice address

1228 W Market St
Warren, OH 44485-2780

Phone

(330) 392-4199

Fax

(330) 392-4904

NPI assigned

Feb 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Johnny Graham, LICDC

Title

Executive Director

Phone

(330) 392-4199

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1140048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407820343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 W MARKET ST",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444852780",
            "telephone_number": "330-392-4199",
            "fax_number": "330-392-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1228 W MARKET ST",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444852780",
            "telephone_number": "330-392-4199",
            "fax_number": "330-392-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YORK AVENUE CHURCH OF GOD TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "330-392-4199",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LICDC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OH",
            "license": "6949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCI NUMBER",
            "identifier": "06949",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Jo Yergan, DC
• David Anthony Yeropoli, D.O.
• Amber Yoder, PA-C
• Kathleen Yoho, APRN, FNP-BC
• Barbara Yonnotti, MED
• Mia York
• Adam Young, CDCA
• Amy Young, MD
• Ashley Young, LPN
• Dixie Jane Young, LPN

• Case Management Agency in Warren, OH
• Providers in Warren, OH by specialty
• Case Management Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.