1407891740 NPI number — OHIO COMMUNITY HEALTH CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407891740 NPI number — OHIO COMMUNITY HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO COMMUNITY HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY DIRECTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407891740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6699 TRI WAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-2604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-336-6133
Provider Business Mailing Address Fax Number:
513-336-6134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4770 DUKE DR
Provider Second Line Business Practice Location Address:
SUITE 195
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-9436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-336-6133
Provider Business Practice Location Address Fax Number:
513-336-6134
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-258-8686

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1289264 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0248557 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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