Provider Demographics
NPI:1578647574
Name:ROCKWELL MENTAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ROCKWELL MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:330-920-8091
Mailing Address - Street 1:1612 PORTAGE TRL STE 12
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1160
Mailing Address - Country:US
Mailing Address - Phone:330-920-8091
Mailing Address - Fax:330-920-1852
Practice Address - Street 1:1612 PORTAGE TRL STE 12
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1160
Practice Address - Country:US
Practice Address - Phone:330-920-8091
Practice Address - Fax:330-920-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI11571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R09349081Medicare ID - Type Unspecified