Provider Demographics
NPI:1396086534
Name:PANNETTE BEHAVIORAL HEALTH CARE LLC
Entity type:Organization
Organization Name:PANNETTE BEHAVIORAL HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-627-6962
Mailing Address - Street 1:8000 TOWN CENTRE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4030
Mailing Address - Country:US
Mailing Address - Phone:440-627-6962
Mailing Address - Fax:440-627-6963
Practice Address - Street 1:8000 TOWN CENTRE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-4030
Practice Address - Country:US
Practice Address - Phone:440-627-6962
Practice Address - Fax:440-627-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008711261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH515293OtherVALUE OPTIONS
OH094872000OtherMAGELLAN HEALTH SERIVCES
OHSW27993Medicare UPIN