Provider Demographics
NPI:1043419237
Name:URBAN MINORITY ALCOHOLISM & DRUG ABUSE OUTREACH PROGRAM OF CINCINNATI
Entity Type:Organization
Organization Name:URBAN MINORITY ALCOHOLISM & DRUG ABUSE OUTREACH PROGRAM OF CINCINNATI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS-ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-541-7099
Mailing Address - Street 1:199 WILLIAM HOWARD TAFT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2103
Mailing Address - Country:US
Mailing Address - Phone:513-541-7099
Mailing Address - Fax:513-541-0989
Practice Address - Street 1:199 WILLIAM HOWARD TAFT RD FL 3
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2103
Practice Address - Country:US
Practice Address - Phone:513-541-7099
Practice Address - Fax:513-541-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1036251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056860Medicaid