| Maryhaven Inc. | |
|
1791 Alum Creek Dr Columbus OH 43207-1708 | |
| (614) 324-5402 | |
| (614) 827-8380 |
| Full Name | Maryhaven Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1791 Alum Creek Dr, Columbus, Ohio |
| Authorized Official Name and Position | Gregory Michael Ritter (BILLING/MEDICAL RECORDS ADMINISTRAT) |
| Authorized Official Contact | 6143245402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryhaven Inc. 1791 Alum Creek Dr Columbus OH 43207-1708 Ph: (614) 324-5402 | Maryhaven Inc. 1791 Alum Creek Dr Columbus OH 43207-1708 Ph: (614) 324-5402 |
| NPI Number | 1245290436 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 10/11/2017 |
| Medicare PECOS PAC ID | 8527281658 |
|---|---|
| Medicare Enrollment ID | O20140519001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245290436 | NPI | - | NPPES |
| 2846951 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1183 (Ohio) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1183 (Ohio) | Secondary |
| Provider Name | Lacey Leigh Ann Stalnaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366925109 PECOS PAC ID: 2769895986 Enrollment ID: I20210107002338 |
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