A Space for Healing
Organization Active NPI Community/Behavioral Health Agency · Mentor, OH
NPI 1669013934 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1669013934
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- A SPACE FOR HEALING
- Practice address
- 8500 Station St Ste 300J
Mentor, OH 44060-4963 - Phone
- (440) 721-8979
- NPI assigned
- Oct 8, 2019
- Organization subpart
- No
Authorized official
- Name
- Ms. Christine Anne Vavro, LISW
- Title
- Trauma Therapist
- Phone
- (440) 413-4637
Practitioners 3
-
Sarah Vivian Jeppesen, LPCC
-
Samantha J Kramer, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200518003206 | OH | Part B Supplier - Clinic/Group Practice | 1951732379 |
Receives reassigned benefits from 2 practitioners Practice locations: Mentor, OH |
National Provider Directory
Locations
8500 Station St
Ste 300-J
Mentor, OH 44060
Phone (216) 264-9688
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
8500 Station St Ste 300J
Mentor, OH 44060-4963
Mailing address
8500 Station Street
Ste 300J
Mentor, OH 44060-5756
Phone (407) 218-9794
Other providers in Mentor, OH
- A Heavenly Helper, LLC
- Rami Abbass
- Abdul Qotaynah O.D., Inc.
- Curtis Abercrombie
- Abilities Unlimited Services LLC
- Lora Abouhassan
All providers in Mentor, OH · Community/Behavioral Health Agency in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.