Healthcare Provider Details

I. General information

NPI: 1801331384
Provider Name (Legal Business Name): FIVE RIVERS HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 WILSON DR
XENIA OH
45385-1810
US

IV. Provider business mailing address

721 MIAMI CHAPEL RD
DAYTON OH
45417-4650
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3535
  • Fax:
Mailing address:
  • Phone: 937-281-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GINA MCFARLANE-EL
Title or Position: CEO
Credential:
Phone: 937-281-6800