Healthcare Provider Details

I. General information

NPI: 1578160438
Provider Name (Legal Business Name): OHIO VALLEY GOODWILL INDUSTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 SPRINGFIELD PIKE
CINCINNATI OH
45215-1121
US

IV. Provider business mailing address

10600 SPRINGFIELD PIKE
CINCINNATI OH
45215-1121
US

V. Phone/Fax

Practice location:
  • Phone: 513-477-6015
  • Fax:
Mailing address:
  • Phone: 513-771-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK HIEMSTRA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 513-771-4800