Provider Demographics
NPI:1760974349
Name:CRN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CRN HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VUKASINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-672-1424
Mailing Address - Street 1:201 W. FRANKLIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-672-1424
Mailing Address - Fax:234-806-4504
Practice Address - Street 1:201 W. FRANKLIN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-672-1424
Practice Address - Fax:234-806-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14345261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290561Medicaid