Provider Demographics
NPI:1164794160
Name:SHAWNEE MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SHAWNEE MENTAL HEALTH CENTER, INC.
Other - Org Name:SHAWNEE FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
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 1:901 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3944
Mailing Address - Country:US
Mailing Address - Phone:740-354-7702
Mailing Address - Fax:740-353-6206
Practice Address - Street 1:715 LANE ST
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-3161
Practice Address - Country:US
Practice Address - Phone:740-533-6206
Practice Address - Fax:740-533-6284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAWNEE MENTAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-07
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health