Provider Demographics
NPI:1982835765
Name:WARREN OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:WARREN OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:513-932-4337
Mailing Address - Street 1:759 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1754
Mailing Address - Country:US
Mailing Address - Phone:513-932-4337
Mailing Address - Fax:513-932-6750
Practice Address - Street 1:759 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1754
Practice Address - Country:US
Practice Address - Phone:513-932-4337
Practice Address - Fax:513-932-6750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALBERT HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0800680251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health