Provider Demographics
NPI:1568845634
Name:JCORBITTLLC
Entity Type:Organization
Organization Name:JCORBITTLLC
Other - Org Name:FAMILY FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:937-422-4349
Mailing Address - Street 1:3688 WALES DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1845
Mailing Address - Country:US
Mailing Address - Phone:937-607-9170
Mailing Address - Fax:
Practice Address - Street 1:3688 WALES DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2439
Practice Address - Country:US
Practice Address - Phone:937-607-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2241108324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility