MEDICARE: RIVER CITY CORRECTIONAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	I0007295	OH

General Provider Information

NPI Number	:	1609041417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY CORRECTIONAL CENTER

Provider Business Mailing Address
First Line	:	3220 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1347
Country	:	US
Telephone Number	:	513-946-6819
Fax Number	:	513-946-6888

Provider Business Practice Location Address
First Line	:	3220 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1347
Country	:	US
Telephone Number	:	513-946-6819
Fax Number	:	513-946-6888

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. HELEN MAGERS
Credential	:	LPCC
Telephone Number	:	513-946-6839

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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Directions to “RIVER CITY CORRECTIONAL CENTER ” Practice Location

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