Provider Demographics
NPI:1851631295
Name:INITIAL INDEPENDENCE INC. OF OHIO
Entity type:Organization
Organization Name:INITIAL INDEPENDENCE INC. OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:MENTAL HEALTH PROF
Authorized Official - Phone:931-434-3358
Mailing Address - Street 1:1432 CROOKED STICK DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5556
Mailing Address - Country:US
Mailing Address - Phone:931-434-3358
Mailing Address - Fax:
Practice Address - Street 1:1432 CROOKED STICK DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5556
Practice Address - Country:US
Practice Address - Phone:931-434-3358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services