Healthcare Provider Details

I. General information

NPI: 1962251033
Provider Name (Legal Business Name): WELLNESSRIDE OF DAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 E DOROTHY LN
KETTERING OH
45429-3810
US

IV. Provider business mailing address

1628 E DOROTHY LN
KETTERING OH
45429-3810
US

V. Phone/Fax

Practice location:
  • Phone: 937-750-8236
  • Fax: 937-600-6071
Mailing address:
  • Phone: 937-750-8236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WILLIAM SLUSSER III
Title or Position: OWNER
Credential:
Phone: 937-750-8236