Provider Demographics
NPI:1518478387
Name:UNITED REHABILITATION SERVICES OF GREATER DAYTON
Entity Type:Organization
Organization Name:UNITED REHABILITATION SERVICES OF GREATER DAYTON
Other - Org Name:UNITED REHABILITATION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-233-1230
Mailing Address - Street 1:4710 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5740
Mailing Address - Country:US
Mailing Address - Phone:937-233-1230
Mailing Address - Fax:937-236-8930
Practice Address - Street 1:4710 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5740
Practice Address - Country:US
Practice Address - Phone:937-233-1230
Practice Address - Fax:937-236-8930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED REHABILITATION SERVICES OF GREATER DAYTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1200685101YP2500X
1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-7591OtherOHIO MENTAL HEALTH CERTIFICATION