Provider Demographics
NPI:1760527394
Name:BELMONT PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:BELMONT PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAW NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-635-7792
Mailing Address - Street 1:500 MACKEY AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1697
Mailing Address - Country:US
Mailing Address - Phone:740-635-7792
Mailing Address - Fax:740-635-7755
Practice Address - Street 1:500 MACKEY AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1697
Practice Address - Country:US
Practice Address - Phone:740-635-7792
Practice Address - Fax:740-635-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130405Medicaid
9321771Medicare PIN
OH0130405Medicaid