Provider Demographics
NPI:1093904120
Name:SHAWNEE MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SHAWNEE MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-354-7702
Mailing Address - Street 1:192 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9584
Mailing Address - Country:US
Mailing Address - Phone:937-544-3400
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:192 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9584
Practice Address - Country:US
Practice Address - Phone:937-544-3400
Practice Address - Fax:740-353-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9218484Medicare PIN