Provider Demographics
NPI:1336675842
Name:ROSCOE, BEVERLY (QMHS)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 APPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-8303
Mailing Address - Country:US
Mailing Address - Phone:740-485-8014
Mailing Address - Fax:
Practice Address - Street 1:3358 APPLE VALLEY DR
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:OH
Practice Address - Zip Code:43028-8303
Practice Address - Country:US
Practice Address - Phone:740-485-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator