Organization
5040 PHILADELPHIA DRIVE OPERATING COMPANY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSH HUFF (ADMINISTRATOR)
(937) 278-0404
Entity
Organization
Contact information
Practice address
5040 PHILADELPHIA DR, DAYTON, OH 45415-3604
(937) 278-0404
(937) 278-0092
Mailing address
5040 PHILADELPHIA DR, DAYTON, OH 45415-3604
(937) 278-0404
(937) 278-0092
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
1923N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2524450
—
OH
Enumeration date
09/30/2005
Last updated
11/28/2011
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