Provider Demographics
NPI:1881794113
Name:CHILD AND ADOLESCENT SPECIALTY CARE OF DAYTON INC.
Entity type:Organization
Organization Name:CHILD AND ADOLESCENT SPECIALTY CARE OF DAYTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GALEMMO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:937-667-7711
Mailing Address - Street 1:1483 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371
Mailing Address - Country:US
Mailing Address - Phone:937-667-7711
Mailing Address - Fax:937-667-8067
Practice Address - Street 1:1483 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371
Practice Address - Country:US
Practice Address - Phone:937-667-7711
Practice Address - Fax:937-667-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382910Medicaid