Healthcare Provider Details

I. General information

NPI: 1437692068
Provider Name (Legal Business Name): PBHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N MAIN ST
NEW LEXINGTON OH
43764-1264
US

IV. Provider business mailing address

203 N MAIN ST
NEW LEXINGTON OH
43764-1264
US

V. Phone/Fax

Practice location:
  • Phone: 740-342-1991
  • Fax: 740-342-2914
Mailing address:
  • Phone: 740-342-1991
  • Fax: 740-342-2914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberPN 100107
License Number StateOH

VIII. Authorized Official

Name: CANDY JANE DINGESS
Title or Position: NURSE
Credential: LPN
Phone: 740-343-0733