Healthcare Provider Details

I. General information

NPI: 1578037396
Provider Name (Legal Business Name): DEVIN ALLEN BROWN CARE COORDINATOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 03/19/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 POE AVE
DAYTON OH
45414-2552
US

IV. Provider business mailing address

2346 DUNCAN DR APT 6
FAIRBORN OH
45324-2055
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-3200
  • Fax: 937-410-7165
Mailing address:
  • Phone: 513-923-8026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: