Provider Demographics
NPI:1255764106
Name:OHIO COMMUNITY SUPPORT LLC
Entity type:Organization
Organization Name:OHIO COMMUNITY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-307-7700
Mailing Address - Street 1:5658 COLERAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6746
Mailing Address - Country:US
Mailing Address - Phone:513-307-7700
Mailing Address - Fax:
Practice Address - Street 1:5658 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6746
Practice Address - Country:US
Practice Address - Phone:513-307-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty