Healthcare Provider Details

I. General information

NPI: 1871005306
Provider Name (Legal Business Name): CRN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 12/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W. FRNAKLIN STREET SUITE B
CENTERVILLE OH
45459
US

IV. Provider business mailing address

201 W. FRANKLIN STREET SUITE B
CENTERVILLE OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-672-1424
  • Fax: 234-806-4504
Mailing address:
  • Phone: 937-672-1424
  • Fax: 234-806-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KEITH ANTHONY VUKASINOVICH
Title or Position: BUSINESS MANAGER/CLINICAL MANAGER
Credential:
Phone: 937-672-1424