Organization
ASSURANCE HEALTH CINCINNATI, LLC
Active
Other names
Assurance Health Wilmington
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE D SMALL (CEO)
(317) 372-6611
Entity
Organization
Contact information
Practice address
11690 GROOMS RD, BLUE ASH, OH 45242-1412
(513) 469-7800
(513) 469-9800
Mailing address
11690 GROOMS RD, BLUE ASH, OH 45242-1412
(765) 374-6044
(765) 374-6043
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
07-7512
OH
283Q00000X
Psychiatric Hospital
07-7517
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0193925
—
OH
01
—
07-7512
STATE LICENSE
OH
01
—
75-7517
WILMINGTON STATE LICENSE NUMBER
OH
Enumeration date
06/30/2015
Last updated
03/17/2018
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