Organization
DAYTON VETERANS AFFAIRS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO MANCINI JR. CRC (VOCATIONAL REHABILITATION SPECIALIS)
(937) 268-6511
Entity
Organization
Contact information
Practice address
3547 FAR HILLS AVE, KETTERING, OH 45429-2501
(937) 293-7484
Mailing address
3547 FAR HILLS AVE, KETTERING, OH 45429-2501
(937) 293-7484
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
S-0016717
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00016730
CERTIFICATION
OH
Enumeration date
10/16/2006
Last updated
08/22/2020
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