Healthcare Provider Details

I. General information

NPI: 1518654094
Provider Name (Legal Business Name): ANANSI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W FRANKLIN ST STE B
CENTERVILLE OH
45459-4700
US

IV. Provider business mailing address

201 W FRANKLIN ST STE B
CENTERVILLE OH
45459-4700
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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