Healthcare Provider Details

I. General information

NPI: 1821894130
Provider Name (Legal Business Name): BGJ COMMUNITY ENRICHMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 WALES DR
DAYTON OH
45405-1844
US

IV. Provider business mailing address

3567 WALES DR
DAYTON OH
45405-1844
US

V. Phone/Fax

Practice location:
  • Phone: 937-718-7271
  • Fax:
Mailing address:
  • Phone: 937-718-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM C ROBERTS II
Title or Position: CO-OWNER
Credential:
Phone: 937-718-7271