Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SCHNEIDER (FINANCE DIRECTOR)
(513) 961-4663
Entity
Organization
Contact information
Practice address
2203 FULTON AVE, CINCINNATI, OH 45206-2504
(513) 961-4663
(513) 961-4681
Mailing address
2203 FULTON AVE, CINCINNATI, OH 45206-2504
(513) 961-4681
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0678
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02996
UPI
OH
05
—
2901104
—
OH
Enumeration date
02/16/2012
Last updated
02/16/2012
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