MEDICARE: COMMUNITY MENTAL HEALTH CENTERS OF WARREN COUNTY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	047	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	047	OTHER	OH	OH DEPT OF MENTAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740278381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MENTAL HEALTH CENTERS OF WARREN COUNTY, INC

Provider Business Mailing Address
First Line	:	975 KINGSVIEW DR BLDG A
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-9562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 KINGSVIEW DR
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-9562
Country	:	US
Telephone Number	:	513-228-7800
Fax Number	:	513-228-7846

Authorized Official
Title or Position	:	CREDENTIALING / BILLING
Name	:	MRS. SHARON BURNETT
Credential	:
Telephone Number	:	513-228-7800

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	11/23/2020

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