Provider Demographics
NPI:1710247770
Name:FAMILY ACCESS TO INTEGRATED RECOVERY
Entity Type:Organization
Organization Name:FAMILY ACCESS TO INTEGRATED RECOVERY
Other - Org Name:CENTRAL CLINIC MENTAL HEALTH ACCESS POINT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-558-9015
Mailing Address - Street 1:311 ALBERT SABIN WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-2838
Mailing Address - Country:US
Mailing Address - Phone:513-558-9005
Mailing Address - Fax:513-558-3880
Practice Address - Street 1:2208 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1420
Practice Address - Country:US
Practice Address - Phone:513-651-4142
Practice Address - Fax:513-651-2310
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CLINIC MENTAL HEALTH ACCESS POINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12949251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC-21-82Medicaid
OH41177OtherCARF
OH9201131Medicare PIN