Provider Demographics
NPI:1558778084
Name:A PRIVATE PLACE LLC
Entity Type:Organization
Organization Name:A PRIVATE PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:REFLEXOLOGIST
Authorized Official - Phone:937-681-0184
Mailing Address - Street 1:8759 MARDI GRAS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1039
Mailing Address - Country:US
Mailing Address - Phone:837-681-0184
Mailing Address - Fax:
Practice Address - Street 1:8759 MARDI GRAS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-1039
Practice Address - Country:US
Practice Address - Phone:937-681-0184
Practice Address - Fax:937-236-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHMANM993092111NN0400X, 251E00000X, 253Z00000X, 282E00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No282E00000XHospitalsLong Term Care Hospital
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Single Specialty