Organization · NPI-2

Self Employee

Custodial Care Facility, Adult Care Home · Dayton, OH

NPI number1669709606
StatusActive
Last updated in NPPESMar 6, 2013

Details

NPI
1669709606
Entity type
Organization (NPI-2)
Legal business name
Self Employee
Organization subpart
No
Enumeration date
Nov 12, 2009
Last updated
Mar 6, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
311ZA0620X Custodial Care Facility, Adult Care HomePN134284IVOHYes

Practice location

3053 Nicholas Rd
Dayton, OH 45417-4322

Phone 937-516-7887

Mailing address

3053 Nicholas Rd
Dayton, OH 45417-4322

Phone 937-516-7887

Authorized official

Kania Monique Mccleskey
Lpn
9375167887

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