Provider Demographics
NPI:1487251088
Name:CALVARY BEHAVIORAL HEALTH OF OHIO, LLC
Entity type:Organization
Organization Name:CALVARY BEHAVIORAL HEALTH OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HEINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-753-9964
Mailing Address - Street 1:7547 CENTRAL PARKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6811
Mailing Address - Country:US
Mailing Address - Phone:513-993-0341
Mailing Address - Fax:
Practice Address - Street 1:7547 CENTRAL PARKE BLVD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6811
Practice Address - Country:US
Practice Address - Phone:513-993-0341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008641Medicaid