Healthcare Provider Details

I. General information

NPI: 1700883741
Provider Name (Legal Business Name): CHILDREN'S HOME CARE OF DAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CHILDRENS PLZ
DAYTON OH
45404-1816
US

IV. Provider business mailing address

18 CHILDRENS PLZ
DAYTON OH
45404-1816
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-4663
  • Fax: 937-641-5339
Mailing address:
  • Phone: 937-641-4663
  • Fax: 937-641-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS BERGMAN
Title or Position: C.F.O.
Credential: CFO
Phone: 937-641-3338