Provider Demographics
NPI:1053379180
Name:FAMILY VIOLENCE PREVENTION CENTER OF GREENE COUNTY
Entity type:Organization
Organization Name:FAMILY VIOLENCE PREVENTION CENTER OF GREENE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-376-8526
Mailing Address - Street 1:380 BELLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-3638
Mailing Address - Country:US
Mailing Address - Phone:937-376-8526
Mailing Address - Fax:937-376-8529
Practice Address - Street 1:380 BELLBROOK AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3638
Practice Address - Country:US
Practice Address - Phone:937-376-8526
Practice Address - Fax:937-376-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0410261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12412Medicare UPIN