Provider Demographics
NPI:1114280690
Name:FIVE RIVERS HEALTH CENTERS
Entity Type:Organization
Organization Name:FIVE RIVERS HEALTH CENTERS
Other - Org Name:FAMILY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLANE-EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-734-6841
Mailing Address - Street 1:721 MIAMI CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-4650
Mailing Address - Country:US
Mailing Address - Phone:937-281-6900
Mailing Address - Fax:
Practice Address - Street 1:2261 PHILADELPHIA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406
Practice Address - Country:US
Practice Address - Phone:937-734-6841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066852Medicaid