Healthcare Provider Details

I. General information

NPI: 1366125866
Provider Name (Legal Business Name): ST VINCENT DE PAUL SOCIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 BROWNLEIGH RD
KETTERING OH
45429-3928
US

IV. Provider business mailing address

120 W APPLE ST
DAYTON OH
45402-2617
US

V. Phone/Fax

Practice location:
  • Phone: 937-630-3950
  • Fax: 630-395-3937
Mailing address:
  • Phone: 937-222-7349
  • Fax: 937-461-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL CHRISTOPOHER GOEBEL
Title or Position: DIRECTOR OF HOUSING MISNITIRES
Credential: LSW, LCDC III
Phone: 937-681-0943