Individual
SHANE KAMBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHS HS CMS
Contact information
Practice address
1433 5TH ST NW, NEW PHILADELPHIA, OH 44663-1223
(440) 260-8300
Mailing address
434 EASTLAND RD, BEREA, OH 44017-1217
(440) 234-2006
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
OH
251S00000X
Community/Behavioral Health Agency
Primary
—
OH
Other
Enumeration date
03/01/2019
Last updated
03/01/2019
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