Healthcare Provider Details

I. General information

NPI: 1346730264
Provider Name (Legal Business Name): KEITH MATTHEWS QMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 ORLEN AVE
CUYAHOGA FALLS OH
44221-2955
US

IV. Provider business mailing address

1225 ORLEN AVE
CUYAHOGA FALLS OH
44221-2955
US

V. Phone/Fax

Practice location:
  • Phone: 216-453-1112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: