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General NPI Number Information
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NPI Number | 1790339703
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Entity Type | Organization
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Legal Business Name | INTERVENTION CENTER OF AMERICA
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 6929 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-2563
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Country | US
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Telephone | 937-204-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 6929 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45415-2563
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Country | US
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Telephone | 937-204-7506
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Fax |
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Authorized Official
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Title or Position | INTAKE COORDINATOR
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Name | LAMICAH BETTS
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Credential |
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Telephone | 937-204-7506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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