Provider Demographics
NPI:1669915484
Name:RESOURCES OF ENDURING HOPE OUTREACH PROGRAM AND EDUCATION, INC.
Entity type:Organization
Organization Name:RESOURCES OF ENDURING HOPE OUTREACH PROGRAM AND EDUCATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LICDC-CS, SW
Authorized Official - Phone:937-245-4792
Mailing Address - Street 1:1443 STEINER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3813
Mailing Address - Country:US
Mailing Address - Phone:937-245-4792
Mailing Address - Fax:
Practice Address - Street 1:1443 STEINER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3813
Practice Address - Country:US
Practice Address - Phone:937-245-4792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150165101Y00000X
OH251B00000X, 251S00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098217Medicaid