Healthcare Provider Details

I. General information

NPI: 1447701404
Provider Name (Legal Business Name): ST. ALOYSIUS ORPHANAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 READING RD
CINCINNATI OH
45237-6107
US

IV. Provider business mailing address

4721 READING RD
CINCINNATI OH
45237-6107
US

V. Phone/Fax

Practice location:
  • Phone: 513-242-7600
  • Fax: 513-242-2845
Mailing address:
  • Phone: 513-242-7600
  • Fax: 513-242-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberE1609
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberE1609
License Number StateOH

VIII. Authorized Official

Name: TONYA SCHMIDTZ
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 513-242-7600