Springvale Health Centers, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Dover, OH
NPI 1487035986 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1487035986
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SPRINGVALE HEALTH CENTERS, INC.
- Practice address
- 204 S Bellevue Ave
Dover, OH 44622-9405 - Phone
- (330) 343-6631
- NPI assigned
- Jun 11, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Joseph J Boroski, MA, PCC-S
- Title
- Ceo
- Phone
- (330) 343-6631
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 3
Practitioners 21
-
Misty Elder, NP
-
Christine Erika Foss, APRN.CNP
-
Kristen Keyser, NP-C
-
Alexandra Kathleen Miller, APRN, FNP-C
-
Jon E. Miller, MD
-
Lori Gorrell, PMHNP
-
Courtney Dawn Slentz, MSN, FNP-C
-
Dawn Ellen White, CNP
-
Steven John Cekanski, LPCC
-
Tanya L Clift, LPCC
-
Nathan Jones, LPCC
-
Marie Christine Klemens, MA. LPCC. LCDC III
-
Leann Frances Mallernee, MSW, LISW-S
-
George T Moses, D.O.
-
Darla R Moore, CNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2101440 | Springvale Health Centers Aka | Certificate of waiver | Sep 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Federally qualified health center certification: CCN 361081
- Legal name
- SPRINGVALE HEALTH CENTERS,INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 9, 2015
- Last certification
- Sep 9, 2015
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 8, 1975 in OH
- Enrollment address
- 204 S Bellevue Ave
Dover, OH 44622-9405
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Shane N Gunnoe |
Corporate Director |
May 28, 2013 | |
| Jennifer Thomas |
Corporate Director |
Jan 25, 2011 | |
| David M Hayman |
Corporate Director |
Jun 1, 2015 | |
| Joseph Boroski |
Corporate Director |
Feb 1, 2010 | |
| W-2 Managing Employee |
May 21, 2015 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Springvale Health Centers,Inc |
Federally qualified health center | Operational/Managerial Control | Apr 7, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150916000072 | OH | Part a Provider - Federally Qualified Health Center (FQHC) | 4688616980 | Practice locations: Dover, OH |
| O20250212001764 | OH | Part B Supplier - Clinic/Group Practice | 4688616980 |
Receives reassigned benefits from 5 practitioners Practice locations: Dover, OH |
National Provider Directory
Locations
204 S Bellevue Ave
Dover, OH 44622
Phone (234) 801-4747
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
204 S Bellevue Ave
Dover, OH 44622-9405
Mailing address
204 S Bellevue Ave
Dover, OH 44622-9405
Phone (330) 343-6631
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0113394 | Medicaid | OH |
Other providers in Dover, OH
- Danielle Sotcan
- Christopher Michael Spolarich
- Springvale Health Centers, Inc
- Springvale Health Centers, Inc.
- Springvale Health Centers, Inc.
- Springvale Health Centers, Inc.
- Springvale Health Centers, Inc.
- Springvale Health Centers, Inc.-Pharmacy
- Springvale Health Centers,Inc
- Springvale Health Centers,Inc
All providers in Dover, OH · Federally Qualified Health Center (FQHC) in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.