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General NPI Number Information
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NPI Number | 1457616195
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Entity Type | Organization
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Legal Business Name | UMADAOP
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 1 ELIZABETH PL 4 WEST PAVILLION SUITE 400
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City | DAYTON
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State | OH
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Zip | 45417-3445
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Country | US
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Telephone | 937-276-2176
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WEST PAVILLION STE 400
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City | DAYTON
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State | OH
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Zip | 45417-5417
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Country | US
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Telephone | 937-276-2176
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. DEBORAH E STYLES
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Credential |
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Telephone | 937-276-2876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1043
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License Number State | OH
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