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Ohio Medicaid Provider
Adult Care Home Facility in Dayton, Ohio
NPI 1659555407

Ohio Medicaid Provider is an Adult Care Home Facility based in Dayton, OH and is specialized in Adult Care Home. Ohio Medicaid Provider practices in Dayton, OH. The NPI Number for Ohio Medicaid Provider is 1659555407 and holds a License No. PN0830007 (Ohio).

The current practice location address for Ohio Medicaid Provider is 322 Albers Ave, Dayton, OH and can be reached out via phone at 937-479-1676.

Location: 322 Albers Ave, Dayton, OH, 45427-1703
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1659555407
Provider Name
Ohio Medicaid Provider
Credential
Provider Entity Type
Organization
Address
322 Albers Ave, Dayton, OH, 45427-1703
Phone Number
937-479-1676
Fax Number
Provider Enumeration Date
12/27/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
2516950 05 OH
institution
Provider Business Practice Location Address Details
Address
322 Albers Ave
City
Dayton
State
Ohio
Zip
45427-1703
Phone Number
937-479-1676
Fax Number
person
Provider Business Mailing Address Details
Address
322 Albers Ave
City
Dayton
State
Ohio
Zip
45427-1703
Phone Number
937-479-1676
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Custodial Care Facility
Speciality
Adult Care Home
Taxonomy
311ZA0620X
License No.
PN0830007 (Ohio)
Definition
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.
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