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Organization
OHIO MEDICAID PROVIDER
Active
Organization
OHIO MEDICAID PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAUNDRA LEE BALLARD LPN (LPN)
(937) 479-1676
Entity
Organization
Contact information
Practice address
322 ALBERS AVE, DAYTON, OH 45427-1703
(937) 479-1676
Mailing address
322 ALBERS AVE, DAYTON, OH 45427-1703
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
PN0830007
OH
Other
Enumeration date
12/27/2007
Last updated
12/27/2007
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