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General NPI Number Information
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NPI Number | 1306671607
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Entity Type | Organization
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Legal Business Name | SHAWNEE MENTAL HEALTH CENTER INC
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1611 27TH ST STE 103
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City | PORTSMOUTH
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State | OH
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Zip | 45662-6932
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Country | US
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Telephone | 740-981-8786
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Fax |
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Provider Business Mailing Address
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Address Line | 901 WASHINGTON ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3944
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Country | US
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Telephone | 740-354-7702
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA HOLSTEIN
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Credential |
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Telephone | 740-355-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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