Healthcare Provider Details

I. General information

NPI: 1740283282
Provider Name (Legal Business Name): COMMUNITY IMPACT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2005
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W PETE ROSE WAY SUITE 350
CINCINNATI OH
45203-1892
US

IV. Provider business mailing address

700 W PETE ROSE WAY SUITE 350
CINCINNATI OH
45203-1875
US

V. Phone/Fax

Practice location:
  • Phone: 513-319-3325
  • Fax:
Mailing address:
  • Phone: 513-319-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E MYLES
Title or Position: EXECUTIVE DIRECTOR
Credential: B.S.
Phone: 513-319-3325