Healthcare Provider Details

I. General information

NPI: 1609392950
Provider Name (Legal Business Name): CORE EDUCATION AND MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E MCMILLAN ST
CINCINNATI OH
45206-1926
US

IV. Provider business mailing address

7672 MONTGOMERY RD #121
CINCINNATI OH
45236-4204
US

V. Phone/Fax

Practice location:
  • Phone: 513-375-4275
  • Fax:
Mailing address:
  • Phone: 513-655-5027
  • Fax: 513-239-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN L BALLEW
Title or Position: CEO
Credential:
Phone: 513-655-5027