Healthcare Provider Details

I. General information

NPI: 1972617728
Provider Name (Legal Business Name): CENTRAL COMMUNITY HEALTH BOARD OF HAMILTON COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 MAXWELL AVE
CINCINNATI OH
45219-2408
US

IV. Provider business mailing address

532 MAXWELL AVE
CINCINNATI OH
45219-2408
US

V. Phone/Fax

Practice location:
  • Phone: 513-559-2000
  • Fax: 513-559-2020
Mailing address:
  • Phone: 513-559-2000
  • Fax: 513-559-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number080
License Number StateOH

VIII. Authorized Official

Name: MR. BENNETT J COOPER JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-559-2913