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General NPI Number Information
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NPI Number | 1245928894
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Entity Type | Organization
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Legal Business Name | GAP COMMUNITY COLLECTIVE
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 436 WARREN ST STE 178
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City | DAYTON
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State | OH
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Zip | 45402-2808
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Country | US
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Telephone | 937-271-1089
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Fax |
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Provider Business Mailing Address
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Address Line | 436 WARREN ST STE 178
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City | DAYTON
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State | OH
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Zip | 45402-2808
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Country | US
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Telephone | 937-271-1089
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KYNA JOHNSON
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Credential |
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Telephone | 937-271-1089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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