Healthcare Provider Details

I. General information

NPI: 1649048554
Provider Name (Legal Business Name): ROSIA SAMANTHA KEENAN QMHS-HS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 KLOTZ RD
BOWLING GREEN OH
43402-4820
US

IV. Provider business mailing address

530 S MAIN ST
LIMA OH
45804-1240
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-7588
  • Fax: 419-354-4977
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: