MEDICARE: PARAMOUNT DEVELOPMENT ASSOCIATION

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	251S00000X	Community/Behavioral Health Agency	01-7509	OH

General Provider Information

NPI Number	:	1659640167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT DEVELOPMENT ASSOCIATION

Provider Business Mailing Address
First Line	:	1818 W 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-2537
Country	:	US
Telephone Number	:	937-263-8176
Fax Number	:	937-263-8175

Provider Business Practice Location Address
First Line	:	1818 W 3RD ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-2537
Country	:	US
Telephone Number	:	937-263-8176
Fax Number	:	937-263-8175

Authorized Official
Title or Position	:	EX. DIRECTOR
Name	:	MRS. MARGO WILLIS
Credential	:
Telephone Number	:	937-263-8176

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	10/29/2013

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