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NPI Code Detail

MEDICARE: GOODWILL EASTER SEALS MIAMI VALLEY

MEDICARE: GOODWILL EASTER SEALS MIAMI VALLEY
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
1261QA0600XAdult Day Care Clinic/Center
2251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

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

General Provider Information

NPI Number : 1619291838
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOODWILL EASTER SEALS MIAMI VALLEY
Provider Business Mailing Address
First Line : 660 S MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-2708
Country : US
Telephone Number : 937-461-4800
Fax Number : 937-461-9578
Provider Business Practice Location Address
First Line : 660 S MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-2708
Country : US
Telephone Number : 937-461-4800
Fax Number : 937-461-9578
Authorized Official
Title or Position : CFO
Name : MR. GRAIG TUSCHONG
Credential :
Telephone Number : 937-461-4800
Provider Enumeration Date : 03/17/2010
Last Update Date : 03/13/2023

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Directions to “GOODWILL EASTER SEALS MIAMI VALLEY ” Practice Location

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