Healthcare Provider Details

I. General information

NPI: 1679945497
Provider Name (Legal Business Name): TALBERT HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 BURNET AVE
CINCINNATI OH
45219-2419
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-8884
  • Fax: 513-281-4131
Mailing address:
  • Phone: 513-872-8884
  • Fax: 513-281-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberPN.133958M-IV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPN133958M-IV
License Number StateOH

VIII. Authorized Official

Name: MRS. JANECIA L KING
Title or Position: SUPERVISING NURSE PRACTITIONER
Credential: NP
Phone: 513-872-8884