MEDICARE: BACK TO BASICS YOUTH EDUCATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	261QA0600X	Adult Day Care Clinic/Center
3	251C00000X	Developmentally Disabled Services Day Training Agency

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	:	1497472211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO BASICS YOUTH EDUCATION

Provider Business Mailing Address
First Line	:	1014 MERRYWOOD DR
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-2445
Country	:	US
Telephone Number	:	937-248-5360
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W 2ND ST STE 611
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-1657
Country	:	US
Telephone Number	:	937-248-5360
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LAWRENCE LINDSEY
Credential	:
Telephone Number	:	937-248-5360

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	01/26/2023

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