Provider Demographics
NPI:1417104860
Name:BUCKEYE COMMUNITY SERVICES, INC
Entity Type:Organization
Organization Name:BUCKEYE COMMUNITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-286-5039
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:220 MORTON ST.
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-0604
Mailing Address - Country:US
Mailing Address - Phone:740-286-5039
Mailing Address - Fax:740-286-8775
Practice Address - Street 1:9267 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9407
Practice Address - Country:US
Practice Address - Phone:740-388-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2710339320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0508098Medicaid