Organization
AO EXPRESS
Active
Other names
LAXO Residential
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES R LACKING (MANAGER)
(937) 369-0807
Entity
Organization
Contact information
Practice address
755 TORRINGTON PL, DAYTON, OH 45406-4441
(937) 369-0807
Mailing address
2800 E 3RD ST STE 1093, DAYTON, OH 45403-2104
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
Primary
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
12/19/2023
Last updated
06/15/2026
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