1831275882 NPI number — CLOVERNOOK CENTER FOR THE BLIND AND VISUALLY IMPAIRED

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 1831275882 NPI number — CLOVERNOOK CENTER FOR THE BLIND AND VISUALLY IMPAIRED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLOVERNOOK CENTER FOR THE BLIND AND VISUALLY IMPAIRED
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:
Provider Other Organization Name Type Code:
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:
1831275882
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:
7000 HAMILTON AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45231-5297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-522-3860
Provider Business Mailing Address Fax Number:
513-728-3946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
368 BIELBY RD.
Provider Second Line Business Practice Location Address:
SUITE #120
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-1199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-537-0417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
USALIS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
LESLIE
Authorized Official Title or Position:
VICE PRESIDENT OF PROGRAM SERVICES
Authorized Official Telephone Number:
513-522-3860

Provider Taxonomy Codes

  • Taxonomy code: 152WL0500X , with the licence number:  35027971 , 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)





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