MEDICARE: SAMARITAN BEHAVIORAL HEALTH, 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
1	261Q00000X	Clinic/Center	503, 11127	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205888641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN BEHAVIORAL HEALTH, INC.

Provider Business Mailing Address
First Line	:	601 S EDWIN C MOSES BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-3424
Country	:	US
Telephone Number	:	937-734-4334
Fax Number	:	937-734-8269

Provider Business Practice Location Address
First Line	:	601 S EDWIN C MOSES BLVD
Second Line	:	FIRST FLOOR, NW BUILDING
City	:	DAYTON
State	:	OH
Zip	:	45417-3424
Country	:	US
Telephone Number	:	937-224-1694
Fax Number	:	937-224-1625

Authorized Official
Title or Position	:	BILLING
Name	:	TABATHA L MASTERS
Credential	:
Telephone Number	:	937-734-4334

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	08/25/2021

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