MEDICARE: FAMILY SERVICE OF CINCINNATI

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396005179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SERVICE OF CINCINNATI

Provider Business Mailing Address
First Line	:	43 E MAIN ST
Second Line	:
City	:	AMELIA
State	:	OH
Zip	:	45102-1993
Country	:	US
Telephone Number	:	513-947-7000
Fax Number	:	513-947-7222

Provider Business Practice Location Address
First Line	:	3730 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45205-1354
Country	:	US
Telephone Number	:	513-354-5617
Fax Number	:	513-947-7222

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES J O'NEIL
Credential	:
Telephone Number	:	513-354-5200

Provider Enumeration Date	:	05/25/2012
Last Update Date	:	08/11/2017

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