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General NPI Number Information
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NPI Number | 1841019718
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Entity Type | Organization
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Legal Business Name | A SAFE HOME AWAY FROM HOME
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 4935 THORAIN CT
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City | DAYTON
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State | OH
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Zip | 45416-1137
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Country | US
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Telephone | 937-559-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 7165 BERRINGER CT
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City | MAINEVILLE
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State | OH
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Zip | 45039-9118
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Country | US
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Telephone | 513-801-4390
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RHONDA HAMPTON
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Credential |
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Telephone | 513-801-4390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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