Provider Demographics
NPI:1750528550
Name:WOMANLINE OF DAYTON, INC
Entity type:Organization
Organization Name:WOMANLINE OF DAYTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:O'BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-223-3446
Mailing Address - Street 1:301 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2838
Mailing Address - Country:US
Mailing Address - Phone:937-223-3446
Mailing Address - Fax:937-223-2384
Practice Address - Street 1:301 E 6TH ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2838
Practice Address - Country:US
Practice Address - Phone:937-223-3446
Practice Address - Fax:937-223-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH636251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH433427OtherMANAGED HEALTH NETWORK, INC.
OKMC34-3300OtherALCOHOL DRUG ADDICTION MENTAL HEALTH SERVICES BOARD OF MONTGOMERY COUNTY