Provider Demographics
NPI:1235120361
Name:THE JEWISH FEDERATION OF GREATER DAYTON
Entity Type:Organization
Organization Name:THE JEWISH FEDERATION OF GREATER DAYTON
Other - Org Name:COVENANT HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-837-2651
Mailing Address - Street 1:4911 COVENANT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2007
Mailing Address - Country:US
Mailing Address - Phone:937-837-2651
Mailing Address - Fax:937-837-5831
Practice Address - Street 1:4911 COVENANT HOUSE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-2007
Practice Address - Country:US
Practice Address - Phone:937-837-2651
Practice Address - Fax:937-837-5831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE JEWISH FEDERATION OF GREATER DAYTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3228314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212844Medicaid
OH365364Medicare Oscar/Certification