=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245967108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETTER BEGINNINGS FOR A BRIGHTER FUTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2516 HOME AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45417-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-813-2663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2516 HOME AVE
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45417-2116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-813-2663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MS. DESHAWNA JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-516-3319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------