Provider Demographics
NPI:1437692068
Name:PBHC
Entity Type:Organization
Organization Name:PBHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DINGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:740-343-0733
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1264
Mailing Address - Country:US
Mailing Address - Phone:740-342-1991
Mailing Address - Fax:740-342-2914
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1264
Practice Address - Country:US
Practice Address - Phone:740-342-1991
Practice Address - Fax:740-342-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 100107324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility