Basic Information
| Provider Information | |||||||||
| NPI: | 1972779932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCIOTO PAINT VALLEY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4449 STATE ROUTE 159 | ||||||||
| Address2: | P.O. BOX 6179 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751260 | ||||||||
| FaxNumber: | 7407750292 | ||||||||
| Practice Location | |||||||||
| Address1: | 4449 STATE ROUTE 159 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407751260 | ||||||||
| FaxNumber: | 7407750292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 05/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | DEAL | ||||||||
| AuthorizedOfficialFirstName: | MADELINE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOC DIR OF FIN | ||||||||
| AuthorizedOfficialTelephone: | 7407751260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 2475576 | 05 | OH | MEDICAID | 000000003420 | 01 | OH | ANTHEM | OTHER |