Healthcare Provider Details

I. General information

NPI: 1023140274
Provider Name (Legal Business Name): HOLY FAMILY PRENATAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 FOREST AVE STE 202
DAYTON OH
45405-4559
US

IV. Provider business mailing address

359 FOREST AVE STE 202
DAYTON OH
45405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-4492
  • Fax: 937-228-4495
Mailing address:
  • Phone: 937-228-4492
  • Fax: 937-228-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VIVIAN KOOB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-226-7414