Provider Demographics
NPI:1972779932
Name:SCIOTO PAINT VALLEY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SCIOTO PAINT VALLEY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC DIR OF FIN
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-775-1260
Mailing Address - Street 1:4449 STATE ROUTE 159
Mailing Address - Street 2:P.O. BOX 6179
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8620
Mailing Address - Country:US
Mailing Address - Phone:740-775-1260
Mailing Address - Fax:740-775-0292
Practice Address - Street 1:4449 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8620
Practice Address - Country:US
Practice Address - Phone:740-775-1260
Practice Address - Fax:740-775-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2475576Medicaid
OH000000003420OtherANTHEM
OH9177903Medicare PIN
OH000000003420OtherANTHEM
OH9177906Medicare PIN
OH9177907Medicare PIN
OH2475576Medicaid
OH9177908Medicare PIN