Provider Demographics
NPI:1063539997
Name:JEFFERSON BEHAVIORAL HEALTH SYSTEM
Entity type:Organization
Organization Name:JEFFERSON BEHAVIORAL HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEPOSH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:740-264-7751
Mailing Address - Street 1:1 ROSS PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2681
Mailing Address - Country:US
Mailing Address - Phone:740-264-7751
Mailing Address - Fax:740-264-2422
Practice Address - Street 1:1 ROSS PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2681
Practice Address - Country:US
Practice Address - Phone:740-264-7751
Practice Address - Fax:740-264-2422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0191251S00000X
OH1308251S00000X
OH1310251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488455Medicaid
OH7063OtherMACSIS LEGACY PROVIDER ID
OH0200517Medicaid
OH24-01Medicaid
OH2410733Medicaid
OH7063OtherMACSIS LEGACY PROVIDER ID