Provider Demographics
NPI:1376659763
Name:URBAN MINORITY ALCOHOLISM & DRUG ABUSE OUTREACH PROGRAM
Entity Type:Organization
Organization Name:URBAN MINORITY ALCOHOLISM & DRUG ABUSE OUTREACH PROGRAM
Other - Org Name:UMADAOP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STYLES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, OCPII
Authorized Official - Phone:937-276-2176
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:4 WEST PAVILION, SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-276-2176
Mailing Address - Fax:937-276-2048
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:4 WEST PAVILION, SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-276-2176
Practice Address - Fax:937-276-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01043Medicare UPIN