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NPI Code Detail

MEDICARE: A LOVING HEART YOUTH SERVICES INC

MEDICARE: A LOVING HEART YOUTH SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2253J00000XFoster Care Agency
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
4320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5251J00000XNursing Care Agency
6251X00000XSupports Brokerage Agency
7251B00000XCase Management Agency
8253Z00000XIn Home Supportive Care Agency
9251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194560110
Entity Type Code : Organization
Provider Name (Legal Business Name) : A LOVING HEART YOUTH SERVICES INC
Provider Business Mailing Address
First Line : 371 W 1ST ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-3012
Country : US
Telephone Number : 937-609-6830
Fax Number :
Provider Business Practice Location Address
First Line : 1415 SALEM AVE
Second Line :
City : DAYTON
State : OH
Zip : 45406-4941
Country : US
Telephone Number : 937-558-8567
Fax Number : 888-783-3165
Authorized Official
Title or Position : COO
Name : WILLIAM PETERSON II
Credential :
Telephone Number : 937-609-6830
Provider Enumeration Date : 07/01/2024
Last Update Date : 05/24/2026

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Directions to “A LOVING HEART YOUTH SERVICES INC ” Practice Location

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