Provider Demographics
NPI:1144688805
Name:CLINTONVILLE-BEECHWOLD COMMUNITY RESOURCES CENTER
Entity type:Organization
Organization Name:CLINTONVILLE-BEECHWOLD COMMUNITY RESOURCES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, ACSW
Authorized Official - Phone:614-268-3539
Mailing Address - Street 1:3222 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1114
Mailing Address - Country:US
Mailing Address - Phone:614-268-3539
Mailing Address - Fax:614-268-5028
Practice Address - Street 1:3222 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1114
Practice Address - Country:US
Practice Address - Phone:614-268-3539
Practice Address - Fax:614-268-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health