Provider Demographics
NPI:1669859856
Name:GREATER CINCINNATI CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:GREATER CINCINNATI CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNTAY
Authorized Official - Middle Name:CORISHA
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-407-6026
Mailing Address - Street 1:3516 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5595
Mailing Address - Country:US
Mailing Address - Phone:513-407-6026
Mailing Address - Fax:513-407-7101
Practice Address - Street 1:3516 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5595
Practice Address - Country:US
Practice Address - Phone:513-407-6026
Practice Address - Fax:513-407-7101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE RESIDENTIAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200780385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child