Provider Demographics
NPI:1639431042
Name:HEALTH RESOURCE CENTER OF CINCINNATI, INC.
Entity Type:Organization
Organization Name:HEALTH RESOURCE CENTER OF CINCINNATI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:RONAN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPCC, PMHCNS-BC
Authorized Official - Phone:513-357-4602
Mailing Address - Street 1:2347 VINE STREET
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1745
Mailing Address - Country:US
Mailing Address - Phone:513-357-4602
Mailing Address - Fax:513-621-2350
Practice Address - Street 1:2347 VINE STREET
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-357-4602
Practice Address - Fax:513-621-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846924Medicaid