Healthcare Provider Details

I. General information

NPI: 1811446834
Provider Name (Legal Business Name): CHRISTIAN COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 SOUTHERN AVE
CINCINNATI OH
45219-3023
US

IV. Provider business mailing address

1712 RACE ST
CINCINNATI OH
45202-6814
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-5624
  • Fax: 513-363-5622
Mailing address:
  • Phone: 513-363-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIM VALE
Title or Position: CEO
Credential:
Phone: 513-381-2247