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NPI Code Detail

MEDICARE: EASTWAY CORPORATION

MEDICARE: EASTWAY CORPORATION
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)1396OH

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 : 1811920556
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTWAY CORPORATION
Provider Business Mailing Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number : 937-496-2000
Fax Number : 937-463-2901
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : MRS. CYBIL SAUM-JOHNSON
Credential :
Telephone Number : 937-496-2000
Provider Enumeration Date : 07/08/2006
Last Update Date : 07/17/2017

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Directions to “EASTWAY CORPORATION ” Practice Location

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