Organization
ACTS 1 AND 8 SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRHONDA ANNE STALLWORTH (ADMINISTRATOR)
(513) 554-2287
Entity
Organization
Contact information
Practice address
260 NORTHLAND BLVD STE 135, CINCINNATI, OH 45246-4908
(513) 554-2287
Mailing address
1286 SIMMONS AVE, CINCINNATI, OH 45215-2327
(513) 554-2287
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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