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NPI Code Detail

MEDICARE: SOUTH COMMUNITY INC.

MEDICARE: SOUTH COMMUNITY 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1770987653
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH COMMUNITY INC.
Provider Business Mailing Address
First Line : 1349 E STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45429-4925
Country : US
Telephone Number : 937-293-1115
Fax Number : 937-293-9455
Provider Business Practice Location Address
First Line : 1349 E STROOP RD
Second Line :
City : DAYTON
State : OH
Zip : 45429-4925
Country : US
Telephone Number : 937-293-1115
Fax Number : 937-293-9455
Authorized Official
Title or Position : PROGRAM DIRECTOR
Name : MRS. STEPHANIE STRATTON
Credential : M.S.E., P.C.C./S
Telephone Number : 937-643-7088
Provider Enumeration Date : 10/21/2014
Last Update Date : 10/21/2014

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Directions to “SOUTH COMMUNITY INC. ” Practice Location

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