Provider Demographics
NPI:1083043848
Name:P.R.I.S.M. BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:P.R.I.S.M. BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENROD
Authorized Official - Suffix:
Authorized Official - Credentials:PCC-S
Authorized Official - Phone:740-974-3584
Mailing Address - Street 1:12538 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43149-9768
Mailing Address - Country:US
Mailing Address - Phone:740-974-3584
Mailing Address - Fax:
Practice Address - Street 1:12538 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCKBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43149-9768
Practice Address - Country:US
Practice Address - Phone:740-974-3584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management