Healthcare Provider Details

I. General information

NPI: 1487251088
Provider Name (Legal Business Name): CALVARY BEHAVIORAL HEALTH OF OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 CENTRAL PARKE BLVD
MASON OH
45040-6811
US

IV. Provider business mailing address

7547 CENTRAL PARKE BLVD
MASON OH
45040-6811
US

V. Phone/Fax

Practice location:
  • Phone: 513-993-0341
  • Fax:
Mailing address:
  • Phone: 513-993-0341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDEN EDWARD HEINEMAN
Title or Position: DIRECTOR
Credential:
Phone: 513-753-9964