Provider Demographics
NPI:1912078312
Name:PSYCHIATRIC HEALTH 1, LTD
Entity Type:Organization
Organization Name:PSYCHIATRIC HEALTH 1, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-450-7620
Mailing Address - Street 1:573 BROOKOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2101
Mailing Address - Country:US
Mailing Address - Phone:740-450-7620
Mailing Address - Fax:740-450-7618
Practice Address - Street 1:573 BROOKOVER AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2101
Practice Address - Country:US
Practice Address - Phone:740-450-7620
Practice Address - Fax:740-450-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007515M2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA7133OtherRR MEDICARE
OH000000222217OtherANTHEM GROUP #
OH=========00OtherOHIO BWC #
OHPS9337741Medicare ID - Type UnspecifiedGROUP MC #