Healthcare Provider Details

I. General information

NPI: 1669859856
Provider Name (Legal Business Name): GREATER CINCINNATI CHILD DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3516 HARRISON AVE
CINCINNATI OH
45211-5595
US

IV. Provider business mailing address

3516 HARRISON AVE
CINCINNATI OH
45211-5595
US

V. Phone/Fax

Practice location:
  • Phone: 513-407-6026
  • Fax: 513-407-7101
Mailing address:
  • Phone: 513-407-6026
  • Fax: 513-407-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number200780
License Number StateOH

VIII. Authorized Official

Name: SHAWNTAY CORISHA OLIVER
Title or Position: CEO/ OWNER
Credential:
Phone: 513-407-6026