Healthcare Provider Details

I. General information

NPI: 1518576016
Provider Name (Legal Business Name): BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 TIMBER LN STE B
DAYTON OH
45414-4528
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-7469
  • Fax:
Mailing address:
  • Phone: 513-454-1460
  • 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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN RANDALL
Title or Position: CFO
Credential:
Phone: 513-454-1468