Provider Demographics
NPI:1871828012
Name:QUEEN TREATMENT CENTERS INC
Entity Type:Organization
Organization Name:QUEEN TREATMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:QUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:740-286-5713
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:P.O. 978
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0978
Mailing Address - Country:US
Mailing Address - Phone:740-418-1487
Mailing Address - Fax:
Practice Address - Street 1:10 LADY AVE
Practice Address - Street 2:P.O. 978
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1018
Practice Address - Country:US
Practice Address - Phone:740-418-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OH324500000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health