Provider Demographics
NPI:1144779679
Name:SOUTHERN OHIO INTEGRATED SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHERN OHIO INTEGRATED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:513-582-1069
Mailing Address - Street 1:3290 MUSGROVE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9151
Mailing Address - Country:US
Mailing Address - Phone:513-582-1069
Mailing Address - Fax:937-444-0044
Practice Address - Street 1:103 DAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8924
Practice Address - Country:US
Practice Address - Phone:937-444-0044
Practice Address - Fax:937-444-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services