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NPI Code Detail

MEDICARE: A LOVING HEART YOUTH SERVICES INC

MEDICARE: A LOVING HEART YOUTH SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1194560110
Entity Type Code : Organization
Provider Name (Legal Business Name) : A LOVING HEART YOUTH SERVICES INC
Provider Business Mailing Address
First Line : 371 W 1ST ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-3012
Country : US
Telephone Number : 937-609-6830
Fax Number :
Provider Business Practice Location Address
First Line : 3559 STANFORD PL
Second Line :
City : DAYTON
State : OH
Zip : 45406-3641
Country : US
Telephone Number : 937-723-8475
Fax Number :
Authorized Official
Title or Position : CEO
Name : DONIELL ELMORE-MURRAY
Credential : QMHS
Telephone Number : 937-723-6893
Provider Enumeration Date : 07/01/2024
Last Update Date : 07/01/2024

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Directions to “A LOVING HEART YOUTH SERVICES INC ” Practice Location

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