Provider Demographics
NPI:1356790935
Name:CENTRAL COMMUNITY HEALTH BOARD OF HAMILTON COUNTY, INC.
Entity type:Organization
Organization Name:CENTRAL COMMUNITY HEALTH BOARD OF HAMILTON COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-293-6250
Mailing Address - Street 1:4522 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2947
Mailing Address - Country:US
Mailing Address - Phone:513-293-6250
Mailing Address - Fax:
Practice Address - Street 1:4522 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2947
Practice Address - Country:US
Practice Address - Phone:513-293-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115127261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone