Healthcare Provider Details

I. General information

NPI: 1447501796
Provider Name (Legal Business Name): ACCESS CENTER FOR INDEPENDENT LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S LUDLOW ST
DAYTON OH
45402-2614
US

IV. Provider business mailing address

901 S LUDLOW ST
DAYTON OH
45402-2614
US

V. Phone/Fax

Practice location:
  • Phone: 937-341-5202
  • Fax: 937-341-5217
Mailing address:
  • Phone: 937-341-5202
  • Fax: 937-341-5217

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: MR. ALAN R COCHRUN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 937-341-5202