Provider Demographics
NPI:1104057280
Name:WARREN OUTPATIENT SERVICES
Entity type:Organization
Organization Name:WARREN OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICE PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC III
Authorized Official - Phone:513-932-4337
Mailing Address - Street 1:759 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1754
Mailing Address - Country:US
Mailing Address - Phone:513-932-4337
Mailing Address - Fax:513-932-6750
Practice Address - Street 1:759 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1754
Practice Address - Country:US
Practice Address - Phone:513-932-4337
Practice Address - Fax:513-932-6750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TALBERT HOUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health