MEDICARE: TALBERT HOUSE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1043440050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBERT HOUSE, INC

Provider Business Mailing Address
First Line	:	2600 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1711
Country	:	US
Telephone Number	:	513-751-7747
Fax Number	:	513-872-5182

Provider Business Practice Location Address
First Line	:	9018 CINTI COLUMBUS RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3565
Country	:	US
Telephone Number	:	513-777-2201
Fax Number	:	513-777-2602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEIL TILOW
Credential	:
Telephone Number	:	513-751-7747

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	07/24/2009

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