Healthcare Provider Details

I. General information

NPI: 1619291838
Provider Name (Legal Business Name): GOODWILL EASTER SEALS MIAMI VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S MAIN ST
DAYTON OH
45402-2708
US

IV. Provider business mailing address

660 S MAIN ST
DAYTON OH
45402-2708
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-4800
  • Fax: 937-461-9578
Mailing address:
  • Phone: 937-461-4800
  • Fax: 937-461-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GRAIG TUSCHONG
Title or Position: CFO
Credential:
Phone: 937-461-4800