| South Community Inc | |
|
3095 Kettering Blvd Moraine OH 45439 | |
| (937) 293-8300 | |
| (937) 534-1353 |
| Full Name | South Community Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3095 Kettering Blvd, Moraine, Ohio |
| Authorized Official Name and Position | Lisa Carter (CEO) |
| Authorized Official Contact | 9372938300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Community Inc 3095 Kettering Blvd Moraine OH 45439 Ph: (937) 293-8300 | South Community Inc 3095 Kettering Blvd Moraine OH 45439 Ph: (937) 293-8300 |
| NPI Number | 1639128176 |
|---|---|
| Provider Enumeration Date | 05/10/2006 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639128176 | NPI | - | NPPES |
| 0320870 | Medicaid | OH | |
| MC34-1000 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 0101 (Ohio) | Primary |
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