Healthcare Provider Details

I. General information

NPI: 1528785227
Provider Name (Legal Business Name): JOSHUA DARNELL MCDANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 SPRINGFIELD STREET
DAYTON OH
45403-1403
US

IV. Provider business mailing address

1628 SPRINGFIELD STREET
DAYTON OH
45403-1403
US

V. Phone/Fax

Practice location:
  • Phone: 937-802-5440
  • Fax: 937-802-5616
Mailing address:
  • Phone: 937-802-5440
  • Fax: 937-802-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: