Basic Information
| Provider Information | |||||||||
| NPI: | 1487913539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY COUNSELING SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | P.O. BOX 765 | ||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Practice Location | |||||||||
| Address1: | 2458 STETZER RD | ||||||||
| Address2: | |||||||||
| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448202066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195622000 | ||||||||
| FaxNumber: | 4195621296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2012 | ||||||||
| LastUpdateDate: | 05/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | SACCENTI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4195622000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 0177 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 2444653 | 05 | OH | MEDICAID |