Provider Demographics
NPI:1417730201
Name:4RM BARRIERS 2 SUCCESS, LLC
Entity Type:Organization
Organization Name:4RM BARRIERS 2 SUCCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CASE MANAGER/ CCHW
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:QBHS, CCHW
Authorized Official - Phone:513-295-8656
Mailing Address - Street 1:4031 MONTGOMERY RD APT 209
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3779
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4031 MONTGOMERY RD APT 209
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3779
Practice Address - Country:US
Practice Address - Phone:513-990-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:4RM BARRIERS 2 SUCCESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1932606092Medicaid