Healthcare Provider Details

I. General information

NPI: 1154547883
Provider Name (Legal Business Name): GOODWILL EASTER SEALS MIAMI VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/25/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MAIN ST
DAYTON OH
45402
US

IV. Provider business mailing address

660 S MAIN ST
DAYTON OH
45402-2708
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-4800
  • Fax: 937-461-9578
Mailing address:
  • Phone: 937-461-4800
  • Fax: 937-461-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberS.12248
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number01-0550
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberS.12248
License Number StateOH

VIII. Authorized Official

Name: MR. GRAIG TUSCHONG
Title or Position: VICE PRESIDENT, CFO
Credential:
Phone: 937-461-4800