Healthcare Provider Details

I. General information

NPI: 1477508406
Provider Name (Legal Business Name): SPRINGVALE HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HOSPITAL DR
DOVER OH
44622-2058
US

IV. Provider business mailing address

201 HOSPITAL DR
DOVER OH
44622-2058
US

V. Phone/Fax

Practice location:
  • Phone: 330-343-6631
  • Fax: 330-343-8188
Mailing address:
  • Phone: 330-343-6631
  • Fax: 330-343-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0242
License Number StateOH

VIII. Authorized Official

Name: JOSEPH J BOROSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: PCC-S
Phone: 330-343-6631