Provider Demographics
NPI:1437608171
Name:PARAMOUNT SUPPORT SERVICES OF ST. CLAIRSVILLE, OHIO, INC.
Entity Type:Organization
Organization Name:PARAMOUNT SUPPORT SERVICES OF ST. CLAIRSVILLE, OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOVALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-526-0540
Mailing Address - Street 1:68138 VINEYARD RD
Mailing Address - Street 2:PO BOX 543
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8481
Mailing Address - Country:US
Mailing Address - Phone:740-526-0540
Mailing Address - Fax:740-526-0541
Practice Address - Street 1:68138 VINEYARD RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8481
Practice Address - Country:US
Practice Address - Phone:740-526-0540
Practice Address - Fax:740-526-0541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601054Medicaid