Provider Demographics
NPI:1285119180
Name:MARYHAVEN
Entity type:Organization
Organization Name:MARYHAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCA
Authorized Official - Prefix:MS
Authorized Official - First Name:SHNIESE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:CDCA/ ON HOLD
Authorized Official - Phone:614-892-2454
Mailing Address - Street 1:100 NOE BIXBY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1460
Mailing Address - Country:US
Mailing Address - Phone:614-702-4503
Mailing Address - Fax:
Practice Address - Street 1:100 NOE BIXBY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1460
Practice Address - Country:US
Practice Address - Phone:614-702-4503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness