Provider Demographics
NPI:1831718212
Name:A L ANDERSON HOUSE LTD
Entity type:Organization
Organization Name:A L ANDERSON HOUSE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-602-0695
Mailing Address - Street 1:238 AUDUBON PARK
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6312
Mailing Address - Country:US
Mailing Address - Phone:513-602-0695
Mailing Address - Fax:
Practice Address - Street 1:238 AUDUBON PARK
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6312
Practice Address - Country:US
Practice Address - Phone:513-602-0695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care