Healthcare Provider Details

I. General information

NPI: 1538883533
Provider Name (Legal Business Name): VONTIJA MCDUFFEY-TOWNSEND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 SOUTHWYCK BLVD STE 108
TOLEDO OH
43614-1597
US

IV. Provider business mailing address

1478 HAGLEY RD
TOLEDO OH
43612-2256
US

V. Phone/Fax

Practice location:
  • Phone: 419-279-4460
  • Fax:
Mailing address:
  • Phone: 419-279-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: