Provider Demographics
NPI:1922368166
Name:MARYHAVEN INC.
Entity type:Organization
Organization Name:MARYHAVEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/MEDICAL RECORDS ADMINISTRAT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC-CS
Authorized Official - Phone:614-324-5402
Mailing Address - Street 1:1791 ALUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1708
Mailing Address - Country:US
Mailing Address - Phone:614-324-5402
Mailing Address - Fax:614-827-8380
Practice Address - Street 1:1791 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1708
Practice Address - Country:US
Practice Address - Phone:614-324-5402
Practice Address - Fax:614-827-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1183324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864566Medicaid
OH2864566OtherPROVIDER #