Organization
DREAMSHINE AT AUTUMN LAKES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY E MINARD (ADMINISTRATOR)
(614) 226-9105
Entity
Organization
Contact information
Practice address
3821 BLUE CHURCH RD, SUNBURY, OH 43074-8922
(614) 226-9105
Mailing address
3821 BLUE CHURCH RD, SUNBURY, OH 43074-8922
(614) 226-9105
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2727115
—
OH
Enumeration date
04/19/2012
Last updated
04/19/2012
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