Provider Demographics
NPI:1437176054
Name:DAYTON OSTEOPATHIC HOSPITAL
Entity Type:Organization
Organization Name:DAYTON OSTEOPATHIC HOSPITAL
Other - Org Name:GRANDVIEW MEDICAL CENTER - PSYCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-762-1644
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-298-3399
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:405 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-7538
Practice Address - Country:US
Practice Address - Phone:937-723-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYTON OSTEOPATHIC HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1246273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3354525Medicaid
OH36S133Medicare Oscar/Certification