Healthcare Provider Details

I. General information

NPI: 1518478387
Provider Name (Legal Business Name): UNITED REHABILITATION SERVICES OF GREATER DAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 OLD TROY PIKE
DAYTON OH
45424-5740
US

IV. Provider business mailing address

4710 OLD TROY PIKE
DAYTON OH
45424-5740
US

V. Phone/Fax

Practice location:
  • Phone: 937-233-1230
  • Fax: 937-236-8930
Mailing address:
  • Phone: 937-233-1230
  • Fax: 937-236-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1200685
License Number StateOH

VIII. Authorized Official

Name: MR. DENNIS GENE GRANT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-233-1230