Provider Demographics
NPI:1396704656
Name:PROJECT IMPACT-DAYTON
Entity type:Organization
Organization Name:PROJECT IMPACT-DAYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-222-5683
Mailing Address - Street 1:115 E 3RD ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5100
Mailing Address - Country:US
Mailing Address - Phone:937-222-5683
Mailing Address - Fax:937-222-4640
Practice Address - Street 1:115 E 3RD ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-5100
Practice Address - Country:US
Practice Address - Phone:937-222-5683
Practice Address - Fax:937-222-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health