Healthcare Provider Details

I. General information

NPI: 1669521761
Provider Name (Legal Business Name): BUCKEYE COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MORTON ST
JACKSON OH
45640-1027
US

IV. Provider business mailing address

PO BOX 604 220 MORTON STREET
JACKSON OH
45640-0604
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-5039
  • Fax: 740-286-8775
Mailing address:
  • Phone: 740-286-5039
  • Fax: 740-286-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. IRIS L MILLIKEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-286-5039