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General NPI Number Information
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NPI Number | 1477261683
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Entity Type | Organization
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Legal Business Name | SIDEWALK SOLDIERS
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 526 XENIA AVE
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City | DAYTON
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State | OH
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Zip | 45410-1824
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Country | US
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Telephone | 937-949-1524
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Fax | 937-791-6613
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Provider Business Mailing Address
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Address Line | 526 XENIA AVE
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City | DAYTON
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State | OH
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Zip | 45410-1824
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Country | US
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Telephone | 513-371-9292
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Fax | 937-791-6613
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Authorized Official
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Title or Position | CEO
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Name | AMY CORNELIUS
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Credential |
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Telephone | 585-336-7600
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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 | 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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