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NPI Code Detail

MEDICARE: PROSPECT HOUSE, INC.

MEDICARE: PROSPECT HOUSE, INC.
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
1324500000XSubstance Abuse Rehabilitation Facility1270OH

General Provider Information

NPI Number : 1780614735
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPECT HOUSE, INC.
Provider Business Mailing Address
First Line : 682 HAWTHORNE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45205-2319
Country : US
Telephone Number : 513-921-1613
Fax Number : 513-921-4244
Provider Business Practice Location Address
First Line : 682 HAWTHORNE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45205-2319
Country : US
Telephone Number : 513-921-1613
Fax Number : 513-921-4244
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DAVID F LOGAN
Credential : L.I.C.D.C., N.C.A.C.
Telephone Number : 513-921-1613
Provider Enumeration Date : 07/04/2006
Last Update Date : 08/22/2020

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Directions to “PROSPECT HOUSE, INC. ” Practice Location

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