Provider Demographics
NPI:1295291474
Name:PERRY BEHAVIORAL HEALTH CHOICES INC
Entity type:Organization
Organization Name:PERRY BEHAVIORAL HEALTH CHOICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-342-1991
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1264
Mailing Address - Country:US
Mailing Address - Phone:740-342-1991
Mailing Address - Fax:740-342-2914
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1264
Practice Address - Country:US
Practice Address - Phone:740-342-1991
Practice Address - Fax:740-342-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1431OtherOHIO DEPARTMENT OF MENTAL HEALTH AND ADDICTION SERVICES
OH2847423Medicaid