Basic Information
| Provider Information | |||||||||
| NPI: | 1063737765 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACCESS HOSPITAL DAYTON LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ACCESS HOSPITAL FOR PSYCHIATRY DAYTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2611 WAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454201833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142250400 | ||||||||
| FaxNumber: | 6143174689 | ||||||||
| Practice Location | |||||||||
| Address1: | 2611 WAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454201833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142250400 | ||||||||
| FaxNumber: | 6143174689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6142250400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 07-5482 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225X00000X | 07-5482 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | 075482 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225200000X | 075482 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 251S00000X | N | Agencies | Community/Behavioral Health | 276400000X | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 310500000X | N | Nursing & Custodial Care Facilities | Intermediate Care Facility, Mental Illness | 320800000X | N | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | 323P00000X | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 385H00000X | N | Respite Care Facility | Respite Care | 332BX2000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 333600000X | N | Suppliers | Pharmacy | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.