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General NPI Number Information
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NPI Number | 1356005532
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Entity Type | Organization
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Legal Business Name | YOUR ROAD TO SUCCESS
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 128 W 1ST ST
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City | DAYTON
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State | OH
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Zip | 45402-1101
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Country | US
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Telephone | 937-266-5072
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Fax |
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Provider Business Mailing Address
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Address Line | 128 W 1ST ST
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City | DAYTON
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State | OH
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Zip | 45402-1101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | TRAVIS L MACK
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Credential |
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Telephone | 937-266-5072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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