Provider Demographics
NPI:1801914650
Name:HEALTHSPAN QBM
Entity type:Organization
Organization Name:HEALTHSPAN QBM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:513-551-1500
Mailing Address - Street 1:225 PICTORIA DR
Mailing Address - Street 2:320
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1615
Mailing Address - Country:US
Mailing Address - Phone:513-551-1500
Mailing Address - Fax:513-551-1489
Practice Address - Street 1:225 PICTORIA DR
Practice Address - Street 2:320
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1615
Practice Address - Country:US
Practice Address - Phone:513-551-1500
Practice Address - Fax:513-551-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health