Healthcare Provider Details

I. General information

NPI: 1932981990
Provider Name (Legal Business Name): BUILDING BRIDGES TO OFFER HEALING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPRINGFIELD ST
DAYTON OH
45403-1110
US

IV. Provider business mailing address

3448 MAUMEE AVE
DAYTON OH
45414-5147
US

V. Phone/Fax

Practice location:
  • Phone: 937-580-8556
  • Fax:
Mailing address:
  • Phone: 937-580-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DION GREEN
Title or Position: OWNER
Credential:
Phone: 937-580-8556