# SELF EMPLOYEE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669709606
- **Authorized official:** KANIA MONIQUE MCCLESKEY (LPN)
- **Authorized official phone:** (937) 516-7887

## Contact information

- **Practice address:** 3053 NICHOLAS RD, DAYTON, OH 45417-4322
- **Practice address phone:** (937) 516-7887
- **Mailing address:** 3053 NICHOLAS RD, DAYTON, OH 45417-4322
- **Mailing address phone:** (937) 516-7887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | PN134284IV | OH | Yes |

## Other

- **Enumeration date:** 11/12/2009
- **Last updated:** 03/06/2013