Healthcare Provider Details

I. General information

NPI: 1386892586
Provider Name (Legal Business Name): BUCKEYE COMMUNITY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 PORTER RD
BIDWELL OH
45614-9152
US

IV. Provider business mailing address

PO BOX 604
JACKSON OH
45640-0604
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-7756
  • Fax:
Mailing address:
  • Phone: 740-286-5039
  • Fax: 740-286-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number2710339
License Number StateOH

VIII. Authorized Official

Name: MRS. CINDY J BROOKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-286-5039