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NPI Code Detail

MEDICARE: MARYHAVEN INC.

MEDICARE: MARYHAVEN INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)1183OH
2251S00000XCommunity/Behavioral Health Agency1183OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245290436
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARYHAVEN INC.
Provider Business Mailing Address
First Line : 1791 ALUM CREEK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1708
Country : US
Telephone Number : 614-324-5402
Fax Number : 614-827-8380
Provider Business Practice Location Address
First Line : 1791 ALUM CREEK DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43207-1708
Country : US
Telephone Number : 614-324-5402
Fax Number : 614-827-8380
Authorized Official
Title or Position : BILLING/MEDICAL RECORDS ADMINISTRAT
Name : MR. GREGORY MICHAEL RITTER
Credential : LPCC, LICDC-CS
Telephone Number : 614-324-5402
Provider Enumeration Date : 03/23/2006
Last Update Date : 10/11/2017

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1487840831 — MRS. DONNA M HOLTZAPFEL CNP
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Directions to “MARYHAVEN INC. ” Practice Location

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