Provider Demographics
NPI:1083672901
Name:TRI-STATE BEHAVIORAL HEALTH CARE, INC.
Entity Type:Organization
Organization Name:TRI-STATE BEHAVIORAL HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KASIRAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATHAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-695-4026
Mailing Address - Street 1:157 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9155
Mailing Address - Country:US
Mailing Address - Phone:740-695-4026
Mailing Address - Fax:740-695-4025
Practice Address - Street 1:157 E LAWN AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9155
Practice Address - Country:US
Practice Address - Phone:740-695-4026
Practice Address - Fax:740-695-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066996S261QM0801X
OH35085372261QM0801X
OH06505RX261QM0801X
OH10008085261QM0801X
OHE0002789261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981577Medicaid
OH2290962Medicaid
OH2592814Medicaid
OH0981577Medicaid
F39679Medicare UPIN
SAO815945Medicare ID - Type Unspecified
1275532046Medicare UPIN