Provider Demographics
NPI:1003929894
Name:CENTRAL CLINIC ADULT CARE
Entity Type:Organization
Organization Name:CENTRAL CLINIC ADULT CARE
Other - Org Name:CC-CHILD/ADULT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-558-9015
Mailing Address - Street 1:311 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2801
Mailing Address - Country:US
Mailing Address - Phone:513-558-5823
Mailing Address - Fax:513-558-3880
Practice Address - Street 1:311 ALBERT SABIN WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2801
Practice Address - Country:US
Practice Address - Phone:513-558-5823
Practice Address - Fax:513-558-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0053261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH41177OtherCARF ACCREDITATION
OHMC-21-02Medicaid
OHMC-21-02Medicaid