Healthcare Provider Details

I. General information

NPI: 1588379465
Provider Name (Legal Business Name): DEE'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 KIPLING DR
DAYTON OH
45406-3822
US

IV. Provider business mailing address

2030 KIPLING DR
DAYTON OH
45406-3822
US

V. Phone/Fax

Practice location:
  • Phone: 937-430-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 937-430-0720