Healthcare Provider Details

I. General information

NPI: 1497338297
Provider Name (Legal Business Name): SENIOR CARE BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48444 BELL SCHOOL RD
CALCUTTA OH
43920-9646
US

IV. Provider business mailing address

5741 SHIELDS RD STE B
CANFIELD OH
44406-9814
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-7100
  • Fax: 330-385-8434
Mailing address:
  • Phone: 330-565-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH CILONE JR.
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 330-565-1097