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General NPI Number Information
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NPI Number | 1649406869
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Entity Type | Organization
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Legal Business Name | WIDOWS HOME OF DAYTON
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 06/02/2009
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Provider Practice Location Address
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Address Line | 50 S FINDLAY ST
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City | DAYTON
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State | OH
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Zip | 45403-2023
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Country | US
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Telephone | 937-252-1661
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Fax |
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Provider Business Mailing Address
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Address Line | 50 S FINDLAY ST
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City | DAYTON
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State | OH
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Zip | 45403-2023
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Country | US
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Telephone | 937-252-1661
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIKE FREEMAN
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Credential |
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Telephone | 937-252-1661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 36D0349051
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License Number State | OH
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