Provider Demographics
NPI:1356654941
Name:DARKE COUNTY MENTAL HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:DARKE COUNTY MENTAL HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-548-1635
Mailing Address - Street 1:PO BOX 895
Mailing Address - Street 2:212 E. MAIN ST
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-0895
Mailing Address - Country:US
Mailing Address - Phone:937-548-1635
Mailing Address - Fax:937-548-1500
Practice Address - Street 1:3130 N COUNTY ROAD 25A
Practice Address - Street 2:SUITE 1000
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-335-7166
Practice Address - Fax:937-339-9400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARKE COUNTY MENTAL HEALTH CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959440Medicaid
OH9249691Medicare PIN