Organization
SOUTH COMMUNITY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CARTER (CEO)
(937) 293-8300
Entity
Organization
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439
(937) 293-8300
(937) 534-1353
Mailing address
3095 KETTERING BLVD, MORAINE, OH 45439
(937) 293-8300
(937) 534-1353
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
0101
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0320870
—
OH
05
—
MC34-1000
—
OH
Enumeration date
05/10/2006
Last updated
05/31/2023
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