Healthcare Provider Details

I. General information

NPI: 1023958345
Provider Name (Legal Business Name): MONTEZ ALLEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 YATES ST
TOLEDO OH
43608-2560
US

IV. Provider business mailing address

1410 YATES ST
TOLEDO OH
43608-2560
US

V. Phone/Fax

Practice location:
  • Phone: 419-708-4120
  • Fax: 419-708-4120
Mailing address:
  • Phone:
  • Fax: 419-708-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: