Provider Demographics
NPI:1255498036
Name:COMMUNITY CONCEPTS, INC.
Entity Type:Organization
Organization Name:COMMUNITY CONCEPTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-398-8885
Mailing Address - Street 1:6699 TRI WAY DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2604
Mailing Address - Country:US
Mailing Address - Phone:513-398-8885
Mailing Address - Fax:513-398-8181
Practice Address - Street 1:6699 TRI WAY DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2604
Practice Address - Country:US
Practice Address - Phone:513-398-8885
Practice Address - Fax:513-398-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1310825315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0233429Medicaid