Healthcare Provider Details

I. General information

NPI: 1669538955
Provider Name (Legal Business Name): MONTGOMERY DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7650 TIMBERCREST DR
HUBER HEIGHTS OH
45424-2405
US

IV. Provider business mailing address

7650 TIMBERCREST DR
HUBER HEIGHTS OH
45424-2405
US

V. Phone/Fax

Practice location:
  • Phone: 937-233-8108
  • Fax: 937-233-1477
Mailing address:
  • Phone: 937-233-8108
  • Fax: 937-233-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG A CARTER
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 937-233-8108