Healthcare Provider Details

I. General information

NPI: 1558778084
Provider Name (Legal Business Name): A PRIVATE PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8759 MARDI GRAS DR
DAYTON OH
45424-1039
US

IV. Provider business mailing address

8759 MARDI GRAS DR
DAYTON OH
45424-1039
US

V. Phone/Fax

Practice location:
  • Phone: 937-681-0184
  • Fax: 937-236-0892
Mailing address:
  • Phone: 837-681-0184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberMANM993092
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberMANM993092
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMANM993092
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberMANM993092
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License NumberMANM993092
License Number StateOH

VIII. Authorized Official

Name: MRS. EILEEN WATSON DARDEN
Title or Position: OWNER
Credential: REFLEXOLOGIST
Phone: 937-681-0184