Provider Demographics
NPI:1487633194
Name:BEN-EL CHILD AND FAMILY CENTER
Entity Type:Organization
Organization Name:BEN-EL CHILD AND FAMILY CENTER
Other - Org Name:BENEL CHILD DEVELOPMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-653-1320
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078
Mailing Address - Country:US
Mailing Address - Phone:937-652-4555
Mailing Address - Fax:937-652-4945
Practice Address - Street 1:1150 SCIOTO ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078
Practice Address - Country:US
Practice Address - Phone:937-652-4555
Practice Address - Fax:937-652-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00741041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10065Medicaid