Provider Demographics
NPI:1982300182
Name:SECOND CHANCE DAYTON GROUP HOME
Entity Type:Organization
Organization Name:SECOND CHANCE DAYTON GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:SHENAE
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-248-5162
Mailing Address - Street 1:7010 HERCULES WAY
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-7505
Mailing Address - Country:US
Mailing Address - Phone:937-248-5168
Mailing Address - Fax:
Practice Address - Street 1:1358 CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4309
Practice Address - Country:US
Practice Address - Phone:937-248-5162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management