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NPI Code Detail

MEDICARE: WIDOWS HOME OF DAYTON

MEDICARE: WIDOWS HOME OF DAYTON
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
1291U00000XClinical Medical Laboratory36D0349051OH

General Provider Information

NPI Number : 1649406869
Entity Type Code : Organization
Provider Name (Legal Business Name) : WIDOWS HOME OF DAYTON
Provider Business Mailing Address
First Line : 50 S FINDLAY ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-2023
Country : US
Telephone Number : 937-252-1661
Fax Number :
Provider Business Practice Location Address
First Line : 50 S FINDLAY ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-2023
Country : US
Telephone Number : 937-252-1661
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. MIKE FREEMAN
Credential :
Telephone Number : 937-252-1661
Provider Enumeration Date : 06/02/2009
Last Update Date : 06/02/2009

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Directions to “WIDOWS HOME OF DAYTON ” Practice Location

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