Provider Demographics
NPI:1205196201
Name:INTEGRATED SERVICES FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:INTEGRATED SERVICES FOR BEHAVIORAL HEALTH
Other - Org Name:INTEGRATED SERVICES OF APPALACHIAN OHIO INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:740-300-0225
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0132
Mailing Address - Country:US
Mailing Address - Phone:740-300-0225
Mailing Address - Fax:833-733-8327
Practice Address - Street 1:1950 MOUNT SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1280
Practice Address - Country:US
Practice Address - Phone:740-300-0225
Practice Address - Fax:833-733-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2916894Medicaid