NPIMap

Organization Active NPI

Shawnee Mental Health Center, Inc.

Doing business as DBA Shawnee Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Coal Grove, OH
National Provider Identifier
1225508195
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHAWNEE MENTAL HEALTH CENTER, INC.
Doing business as
DBA Shawnee Family Health Center
Practice address
225 Carlton Davidson LN
Coal Grove, OH 45638-2924
Phone
(740) 533-6280
Fax
(740) 353-1662
NPI assigned
Dec 4, 2018
Last updated
May 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cynthia Holstein
Title
Ceo
Phone
(740) 355-8686

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

225 Carlton Davidson LN
Coal Grove, OH 45638-2924

Mailing address

901 Washington St
Portsmouth, OH 45662-3944
Phone (740) 355-8686

Other identifiers 1

IdentifierTypeStateIssuer
0339264MedicaidOH

Other names 1

  • DBA Shawnee Family Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
RESTful URL shawnee.mental.health.center@clinisync.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190214000950 OH Part A Provider - Federally Qualified Health Center (FQHC) 7012902075 Practice locations: Coal Grove, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225508195. Details of each certification follow.

Federally qualified health center certification: CCN 721800

Legal name
SHAWNEE MENTAL HEALTH CENTER INC
Doing business as
SHAWNEE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 14, 2019
Last certification
Feb 14, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 23, 1973 in OH
Enrollment address
225 Carlton Davidson LN
Coal Grove, OH 45638-2924

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shawnee Mental Health Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Garry Messer Individual Corporate OfficerBoard Member Jan 1, 2024
Sarah Richards Individual Corporate OfficerBoard Member Jan 1, 2024
Jill Cottrill Individual Corporate OfficerCfo Jan 1, 2024
Gary Maddix Individual Corporate Director Jan 1, 2024
Cynthia Holstein Individual Corporate OfficerCeo May 19, 2013
W-2 Managing EmployeeCeo May 19, 2013
Amy Wagner Welch Individual Corporate OfficerBoard Member Jan 1, 2024
Jerry Bennett Individual Corporate OfficerBoard Member Jan 1, 2024
Karyn Jo Anne Justice Individual Corporate OfficerBoard Member Jan 1, 2024
Brittany Stanfield-Fegley Individual Corporate OfficerChairperson Jan 1, 2024
Ashley Endlich Individual W-2 Managing EmployeeAd; Apr 21, 2025
Robert Craig Harvey Individual Corporate OfficerBoard Member Jan 1, 2024
Lee Bass Individual Corporate OfficerBoard Member Jan 1, 2024
Marissa Parker Individual Corporate OfficerBoard Member Jan 1, 2024
Sara Fry Individual Corporate OfficerSecretary/Treasurer Jan 1, 2024
Leslie Jewell Individual Corporate OfficerBoard Member Jan 1, 2024
Mary Holsonback Individual W-2 Managing Employee Jan 1, 2025
Chrystal Martin Individual Corporate OfficerBoard Member Jan 1, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1543881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1225508195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 WASHINGTON ST",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456623944",
            "telephone_number": "740-355-8686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CARLTON DAVIDSON LN",
            "city": "COAL GROVE",
            "state": "OH",
            "postal_code": "456382924",
            "telephone_number": "740-533-6280",
            "fax_number": "740-353-1662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE MENTAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-04",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "HOLSTEIN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "740-355-8686"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0339264",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "REST",
            "endpointTypeDescription": "RESTful URL",
            "endpoint": "shawnee.mental.health.center@clinisync.medicity.net",
            "affiliation": "N",
            "address_1": "901 Washington St",
            "city": "Portsmouth",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456623944",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "DBA Shawnee Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DBA Shawnee Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coal Grove, OH

Sources for this page

Verify at the official NPI Registry.