Provider Demographics
NPI:1699190041
Name:CENTRAL COMMUNITY HEALTH BOARD
Entity type:Organization
Organization Name:CENTRAL COMMUNITY HEALTH BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-559-2000
Mailing Address - Street 1:530 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2408
Mailing Address - Country:US
Mailing Address - Phone:513-559-2000
Mailing Address - Fax:
Practice Address - Street 1:530 MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2408
Practice Address - Country:US
Practice Address - Phone:513-559-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH080251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMC21-12Medicaid
OHMC21-12Medicaid
OHCE9150531Medicare Oscar/Certification