Organization · NPI-2

Ohio Medicaid Provider

Custodial Care Facility, Adult Care Home · Dayton, OH

NPI number1659555407
StatusActive
Last updated in NPPESDec 27, 2007

Details

NPI
1659555407
Entity type
Organization (NPI-2)
Legal business name
Ohio Medicaid Provider
Organization subpart
No
Enumeration date
Dec 27, 2007
Last updated
Dec 27, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
311ZA0620X Custodial Care Facility, Adult Care Homepn0830007OHYes

Practice location

322 Albers Ave
Dayton, OH 45427-1703

Phone 937-479-1676

Mailing address

322 Albers Ave
Dayton, OH 45427-1703

Authorized official

Saundra Lee Ballard
Lpn
9374791676

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