Provider Demographics
NPI:1447596713
Name:SOUTH COMMUNITY BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:SOUTH COMMUNITY BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/STUDENT PLACEMENTS
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRABILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PCC-S, NCC
Authorized Official - Phone:937-534-1572
Mailing Address - Street 1:3095 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3095 KETTERING BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1983
Practice Address - Country:US
Practice Address - Phone:937-252-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health