NPIMap

Organization Active NPI

Fatherhood Revisited

  • Case Management Agency
  • Blue Ash, OH
National Provider Identifier
1144762337
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
FATHERHOOD REVISITED
Practice address
10925 Reed Hartman Hwy Ste 310C
Blue Ash, OH 45242-2842
Phone
(513) 549-4172
Fax
(513) 586-0452
NPI assigned
Nov 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Keisha Renee PettijohnNPI 1528487154
Title
Ceo/Founder
Phone
(513) 549-4172

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

10925 Reed Hartman Hwy Ste 310C
Blue Ash, OH 45242-2842

Mailing address

PO Box 12685
Cincinnati, OH 45212-0685
Phone (513) 549-4172

National Provider Directory

National Provider Directory

Locations

10925 Reed Hartman Hwy
Ste 310C
Blue Ash, OH 45242
Phone (513) 549-4172

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1144762337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12685",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452120685",
            "telephone_number": "513-549-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10925 REED HARTMAN HWY STE 310C",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452422842",
            "telephone_number": "513-549-4172",
            "fax_number": "513-586-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FATHERHOOD REVISITED",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-06",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "PETTIJOHN",
        "authorized_official_first_name": "KEISHA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "513-549-4172",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Ash, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.