| Fatherhood Revisited | |
|
10925 Reed Hartman Hwy Ste 310c Blue Ash OH 45242-2842 | |
| (513) 549-4172 | |
| (513) 586-0452 |
| Full Name | Fatherhood Revisited |
|---|---|
| Speciality | Case Management |
| Location | 10925 Reed Hartman Hwy Ste 310c, Blue Ash, Ohio |
| Authorized Official Name and Position | Keisha Renee Pettijohn (CEO/FOUNDER) |
| Authorized Official Contact | 5135494172 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fatherhood Revisited Po Box 12685 Cincinnati OH 45212-0685 Ph: (513) 549-4172 | Fatherhood Revisited 10925 Reed Hartman Hwy Ste 310c Blue Ash OH 45242-2842 Ph: (513) 549-4172 |
| NPI Number | 1144762337 |
|---|---|
| Provider Enumeration Date | 11/06/2016 |
| Last Update Date | 03/14/2022 |
| Certification Date | 03/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144762337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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