Provider Demographics
NPI:1518654094
Name:ANANSI, LLC
Entity Type:Organization
Organization Name:ANANSI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VUKASINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-672-1424
Mailing Address - Street 1:201 W FRANKLIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4700
Mailing Address - Country:US
Mailing Address - Phone:937-672-1424
Mailing Address - Fax:
Practice Address - Street 1:201 W FRANKLIN ST STE B
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4700
Practice Address - Country:US
Practice Address - Phone:937-672-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder