Provider Demographics
NPI:1598719361
Name:CHRISTIAN COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:CHRISTIAN COMMUNITY HEALTH SERVICES
Other - Org Name:CROSSROAD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-381-2247
Mailing Address - Street 1:5 E LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-8202
Mailing Address - Country:US
Mailing Address - Phone:513-381-2247
Mailing Address - Fax:513-381-2256
Practice Address - Street 1:5 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-8202
Practice Address - Country:US
Practice Address - Phone:513-381-2247
Practice Address - Fax:513-381-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2162181Medicaid
OH=========OtherTAX ID
OH=========OtherTAX ID