Provider Demographics
NPI:1063652527
Name:DECLARE THERAPY CENTER INC
Entity Type:Organization
Organization Name:DECLARE THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PURCELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:513-290-7908
Mailing Address - Street 1:700 W PETE ROSE WAY STE 456
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45203-1875
Mailing Address - Country:US
Mailing Address - Phone:513-834-7050
Mailing Address - Fax:
Practice Address - Street 1:700 W PETE ROSE WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-1892
Practice Address - Country:US
Practice Address - Phone:513-290-7908
Practice Address - Fax:513-834-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85387101YA0400X
OHE0000656, 85387251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty