Organization
AMAZING GRACE TREATMENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYES'A NELLOMS ADN, QMHS (PROGRAM MANAGER)
(937) 231-8773
Entity
Organization
Contact information
Practice address
17 INDIANA AVE, DAYTON, OH 45410-2307
(937) 640-3400
Mailing address
17 INDIANA AVE, DAYTON, OH 45410-2307
(937) 640-3400
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/12/2024
Last updated
03/23/2026
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