| NPI | 1689209009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA WHITESELL Nurse Practitioner 937-694-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2022-12-13 |