Provider Demographics
NPI:1326651084
Name:BOYS TO MEN TRANSITIONAL HOME INC.
Entity Type:Organization
Organization Name:BOYS TO MEN TRANSITIONAL HOME INC.
Other - Org Name:BOYS TO MEN TRANSITIONAL HOME INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:GRUBBS
Authorized Official - Last Name:PIPPINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-673-8951
Mailing Address - Street 1:117 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2643
Mailing Address - Country:US
Mailing Address - Phone:937-673-8951
Mailing Address - Fax:937-221-8003
Practice Address - Street 1:117 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2643
Practice Address - Country:US
Practice Address - Phone:937-673-8951
Practice Address - Fax:937-221-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1275019531Medicaid
OH1275019531Medicaid