Provider Demographics
NPI:1639768187
Name:SPRINGVALE HEALTH CENTERS, INC.-PHARMACY
Entity Type:Organization
Organization Name:SPRINGVALE HEALTH CENTERS, INC.-PHARMACY
Other - Org Name:COMMUNITY MENTAL HEALTHCARE, INC. -PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:330-343-6613
Mailing Address - Street 1:201 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 S BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9405
Practice Address - Country:US
Practice Address - Phone:330-365-1781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGVALE HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-11
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy