| Goodwill Easter Seals Of Miami Valley | |
|
660 S Main St Dayton OH 45402 | |
| (937) 461-4800 | |
| (937) 461-9578 |
| Full Name | Goodwill Easter Seals Of Miami Valley |
|---|---|
| Speciality | Counselor |
| Location | 660 S Main St, Dayton, Ohio |
| Authorized Official Name and Position | Graig Tuschong (VICE PRESIDENT, CFO) |
| Authorized Official Contact | 9374614800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodwill Easter Seals Of Miami Valley 660 S Main St Dayton OH 45402-2708 Ph: (937) 461-4800 | Goodwill Easter Seals Of Miami Valley 660 S Main St Dayton OH 45402 Ph: (937) 461-4800 |
| NPI Number | 1154547883 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 10/11/2024 |
| Certification Date | 09/23/2024 |
| Medicare PECOS PAC ID | 1951650944 |
|---|---|
| Medicare Enrollment ID | O20180824000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154547883 | NPI | - | NPPES |
| 1154547883 | Medicaid | OH | |
| 2284504 | Medicaid | OH | |
| 2913646 | Medicaid | OH |
| Provider Name | Mary Leyendecker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417322397 PECOS PAC ID: 3173826559 Enrollment ID: I20160119000664 |
| Provider Name | Dawn Cooksey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609006519 PECOS PAC ID: 5193074185 Enrollment ID: I20180905001513 |
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