OHIO MEDICAID PROVIDER NPI 1659555407

NPI Information

OHIO MEDICAID PROVIDER is an adult care home custodial care facility in Dayton, OH. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. OHIO MEDICAID PROVIDER NPI is 1659555407. The provider is registered as an organization entity type.

The provider's business location address is:

322 ALBERS AVE
DAYTON, OH
ZIP 45427-703
Phone: (937) 479-1676

The provider's authorized official is Saundra Lee Ballard .
The authorized official title is Lpn and has the following contact phone number (937) 479-1676.

The enumeration date for this NPI number is 12/27/2007 and was last updated on 12/27/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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