Healthcare Provider Details

I. General information

NPI: 1497817092
Provider Name (Legal Business Name): MONTGOMERY COUNTY COURT HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ELIZABETH PLACE
DAYTON OH
45408
US

IV. Provider business mailing address

117 S MAIN ST FSO - SECOND FLOOR
DAYTON OH
45422-2005
US

V. Phone/Fax

Practice location:
  • Phone: 937-461-5223
  • Fax: 937-461-7010
Mailing address:
  • Phone: 937-225-4543
  • Fax: 937-496-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY A COOPER
Title or Position: HEALTH COMMISSIONER
Credential: MS
Phone: 937-225-5700