Healthcare Provider Details

I. General information

NPI: 1508895046
Provider Name (Legal Business Name): GREENE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 DAYTON XENIA RD
XENIA OH
45385-2607
US

IV. Provider business mailing address

711 DAYTON XENIA RD
XENIA OH
45385-2607
US

V. Phone/Fax

Practice location:
  • Phone: 937-562-7590
  • Fax: 937-562-7593
Mailing address:
  • Phone: 937-562-7590
  • Fax: 937-562-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENISE R PERCIVAL
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 937-562-7590