Basic Information
| Provider Information | |||||||||
| NPI: | 1770175804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMANIS | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | ARLENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 132 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457010132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406449872 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150B MILL ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLEPORT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457601071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003218293 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2021 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.