Provider Demographics
NPI:1336386549
Name:HEALTH SPECIALISTS OF DAYTON INC
Entity Type:Organization
Organization Name:HEALTH SPECIALISTS OF DAYTON INC
Other - Org Name:CHRISTOPHER J HEATHER APN AND CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:BEHAVIORAL HEALTH PAVILION
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2584
Mailing Address - Country:US
Mailing Address - Phone:513-420-5252
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:BEHAVIORAL HEALTH PAVILION
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2584
Practice Address - Country:US
Practice Address - Phone:513-420-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SPECIALISTS OF DAYTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-09
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.201005-COA1364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2944907Medicaid
OH2944907Medicaid