1508423757 NPI number — CAYLA MARIE HANES LSW

Table of content: CAYLA MARIE HANES LSW (NPI 1508423757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508423757 NPI number — CAYLA MARIE HANES LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANES
Provider First Name:
CAYLA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508423757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 KARI LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43723-9715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-255-3112
Provider Business Mailing Address Fax Number:
740-439-1031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COLEMAN HEALTH SERVICES
Provider Second Line Business Practice Location Address:
61580 BAYBERRY DR.
Provider Business Practice Location Address City Name:
ST. CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-996-7010
Provider Business Practice Location Address Fax Number:
740-346-0236
Provider Enumeration Date:
05/23/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  170325 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: S.2207767 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S.2207767 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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