Provider Demographics
NPI:1689815482
Name:COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Other - Org Name:EAST DAYTON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-586-9733
Mailing Address - Street 1:1323 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6714
Mailing Address - Country:US
Mailing Address - Phone:937-586-9733
Mailing Address - Fax:937-586-9736
Practice Address - Street 1:2132 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-1977
Practice Address - Country:US
Practice Address - Phone:937-528-6850
Practice Address - Fax:937-528-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH93.224261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2933517Medicaid
OH2933517Medicaid