Provider Demographics
NPI:1861705212
Name:RAVENWOOD MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:RAVENWOOD MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPSTW
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-285-3568
Mailing Address - Street 1:12557 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9009
Mailing Address - Country:US
Mailing Address - Phone:440-285-3568
Mailing Address - Fax:440-285-4552
Practice Address - Street 1:12557 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9009
Practice Address - Country:US
Practice Address - Phone:440-285-3568
Practice Address - Fax:440-285-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization