| Maryhaven Inc. | |
|
1791 Alum Creek Dr Columbus OH 43207-1708 | |
| (614) 324-5402 | |
| (614) 827-8380 |
| Full Name | Maryhaven Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1791 Alum Creek Dr, Columbus, Ohio |
| Authorized Official Name and Position | Gregory Michael Ritter (BILLING/MEDICAL RECORDS ADMINISTRAT) |
| Authorized Official Contact | 6143245402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryhaven Inc. 1791 Alum Creek Dr Columbus OH 43207-1708 Ph: (614) 324-5402 | Maryhaven Inc. 1791 Alum Creek Dr Columbus OH 43207-1708 Ph: (614) 324-5402 |
| NPI Number | 1245290436 |
|---|---|
| Provider Enumeration Date | 03/23/2006 |
| Last Update Date | 10/11/2017 |
| Medicare PECOS PAC ID | 8527281658 |
|---|---|
| Medicare Enrollment ID | O20140519001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245290436 | NPI | - | NPPES |
| 2846951 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1183 (Ohio) | Secondary |
| 251S00000X | Community/behavioral Health | 1183 (Ohio) | Primary |
| Provider Name | Pamela R Gent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780196600 PECOS PAC ID: 5092073379 Enrollment ID: I20171213003189 |
| Provider Name | Lacey Stalnaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366925109 PECOS PAC ID: 2769895986 Enrollment ID: I20210107002338 |
| Provider Name | Krista Ann Benedict |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407345390 PECOS PAC ID: 2062895097 Enrollment ID: I20220823004182 |
| Provider Name | Derrick Daggett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1205330263 PECOS PAC ID: 4385095835 Enrollment ID: I20240109001923 |
| Provider Name | Tomoko Kobayashi Sherrod |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538502760 PECOS PAC ID: 4183077761 Enrollment ID: I20240131000234 |
| Provider Name | Patrick Henry |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427608207 PECOS PAC ID: 0941640783 Enrollment ID: I20240426002955 |
| Provider Name | Erin K Michel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447886098 PECOS PAC ID: 6305288127 Enrollment ID: I20240524001976 |
| Provider Name | Katelyn J Zuk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770105447 PECOS PAC ID: 1951824739 Enrollment ID: I20250402001878 |
| Provider Name | Angel Mitchell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225894827 PECOS PAC ID: 8820511538 Enrollment ID: I20250402002813 |
| Provider Name | Xingyao Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598441511 PECOS PAC ID: 1052834736 Enrollment ID: I20250403000321 |
| Provider Name | Tara R Steranko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831922145 PECOS PAC ID: 2163945841 Enrollment ID: I20250403000651 |
| Provider Name | Alana Mosier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952957912 PECOS PAC ID: 7214451665 Enrollment ID: I20250408001103 |
| Provider Name | Mary Zapata |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679112015 PECOS PAC ID: 0446774400 Enrollment ID: I20250411000421 |
| Provider Name | Spencer Mead Schell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699351486 PECOS PAC ID: 3072915552 Enrollment ID: I20250520004299 |
| Provider Name | Regina Mcree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326478397 PECOS PAC ID: 6800028200 Enrollment ID: I20250530003200 |
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