MEDICARE: 4RM BARRIERS 2 SUCCESS, LLC

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	:	1417730201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4RM BARRIERS 2 SUCCESS, LLC

Provider Business Mailing Address
First Line	:	4031 MONTGOMERY RD APT 209
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4031 MONTGOMERY RD APT 209
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3779
Country	:	US
Telephone Number	:	513-990-2619
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH CASE MANAGER/ CCHW
Name	:	MR. TERRY L GRIFFIN
Credential	:	QBHS, CCHW
Telephone Number	:	513-295-8656

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/15/2023

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