Provider Demographics
NPI:1265721542
Name:COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:165 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8472
Practice Address - Country:US
Practice Address - Phone:937-972-0303
Practice Address - Fax:937-262-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2022-02-16
Deactivation Date:2021-12-21
Deactivation Code:
Reactivation Date:2022-02-16
Provider Licenses
StateLicense IDTaxonomies
OH93.224261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3152510Medicaid
OH36-1978Medicare PIN