1578625679 NPI number — MONTGOMERY COUNTY COURT HOUSE

Table of content: (NPI 1578625679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578625679 NPI number — MONTGOMERY COUNTY COURT HOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY COUNTY COURT HOUSE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY - HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578625679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 S MAIN ST
Provider Second Line Business Mailing Address:
FSO - SECOND FLOOR
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45422-2005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-225-4543
Provider Business Mailing Address Fax Number:
937-496-3318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 S MAIN ST HOME CARE - 3RD FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-225-4500
Provider Business Practice Location Address Fax Number:
937-496-3318
Provider Enumeration Date:
12/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
HEALTH COMMISSIONER
Authorized Official Telephone Number:
937-225-5700

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000002884 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0048719 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0048719 . This is a "MOLINA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31600172 . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".