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General NPI Number Information
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NPI Number | 1609406297
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Entity Type | Organization
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Legal Business Name | SEEDS 4 LIFE INC
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Dates
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Enumeration Date | 01/22/2020
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 4812 FREDERICK PIKE
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City | DAYTON
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State | OH
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Zip | 45414-3835
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Country | US
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Telephone | 937-949-7095
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | ENGLEWOOD
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State | OH
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Zip | 45322-0007
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Country | US
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Telephone | 937-949-7095
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Fax |
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Authorized Official
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Title or Position | EXEC. DIRECTOR
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Name | MRS. DONNA CLARK
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Credential | CMS,QMHS
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Telephone | 937-949-7095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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