Provider Demographics
NPI:1649406869
Name:WIDOWS HOME OF DAYTON
Entity Type:Organization
Organization Name:WIDOWS HOME OF DAYTON
Other - Org Name:THE WIDOWS HOME OF DAYTON - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-252-1661
Mailing Address - Street 1:50 S FINDLAY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2023
Mailing Address - Country:US
Mailing Address - Phone:937-252-1661
Mailing Address - Fax:
Practice Address - Street 1:50 S FINDLAY ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2023
Practice Address - Country:US
Practice Address - Phone:937-252-1661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0349051291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory