Organization
THE EDNA BROOKS FOUNDATION, INC.
Active
Other names
My Sister's Place
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY COOKE LISW (EXECUTIVE DIRECTOR)
(740) 593-7125
Entity
Organization
Contact information
Practice address
142 E STATE ST, ATHENS, OH 45701-1746
(740) 593-7125
(740) 594-7122
Mailing address
PO BOX 1158, ATHENS, OH 45701-1158
(740) 593-7125
(740) 594-7122
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0003
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10167
—
OH
Enumeration date
06/24/2006
Last updated
12/21/2016
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