Healthcare Provider Details

I. General information

NPI: 1992171896
Provider Name (Legal Business Name): YOUNG WOMEN'S CHRISTIAN ASSOCIATION OF DAYTON OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W 3RD ST
DAYTON OH
45402-1814
US

IV. Provider business mailing address

141 W 3RD ST
DAYTON OH
45402-1814
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5550
  • Fax: 937-222-0610
Mailing address:
  • Phone: 937-461-5550
  • Fax: 937-222-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON TL ISOM
Title or Position: CEO
Credential:
Phone: 937-461-5550