Healthcare Provider Details

I. General information

NPI: 1912652876
Provider Name (Legal Business Name): 5900 WEST CHESTER OPERATING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 W CHESTER RD STE C
WEST CHESTER OH
45069-2951
US

IV. Provider business mailing address

4700 ASHWOOD DR STE 200
BLUE ASH OH
45241-2424
US

V. Phone/Fax

Practice location:
  • Phone: 513-777-2428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YITZHAK ROSEDALE
Title or Position: PRESIDENT
Credential:
Phone: 513-489-7100