Healthcare Provider Details

I. General information

NPI: 1235056250
Provider Name (Legal Business Name): A LOVING HEART YOUTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SALEM AVE
DAYTON OH
45406-4941
US

IV. Provider business mailing address

1415 SALEM AVE
DAYTON OH
45406-4941
US

V. Phone/Fax

Practice location:
  • Phone: 937-609-6830
  • Fax:
Mailing address:
  • Phone: 937-609-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM PETERSON II
Title or Position: COO
Credential: QMHS, CDCA
Phone: 937-609-6830