Organization
INDEPENDENT COMMUNITY SERVICES
Active
Organization
INDEPENDENT COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KARISSA JANAY MARSHALL (CEO)
(423) 316-0557
Entity
Organization
Contact information
Practice address
675 DEIS DR # 201, FAIRFIELD, OH 45014-8136
(513) 817-4888
Mailing address
675 DEIS DR # 201, FAIRFIELD, OH 45014-8136
(513) 817-4888
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902322027
—
OH
Enumeration date
10/08/2020
Last updated
10/08/2020
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