Organization
HOLT STREET MIRACLE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER GILBERT (EXECUTIVE DIRECTOR)
(937) 222-7420
Entity
Organization
Contact information
Practice address
420 HOLT ST, DAYTON, OH 45402-6335
(937) 222-7420
Mailing address
420 HOLT ST, DAYTON, OH 45402-6335
(937) 222-7420
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
13086
OH
251S00000X
Community/Behavioral Health Agency
Primary
13086
OH
251V00000X
Voluntary or Charitable Agency
13086
OH
Other
Enumeration date
05/08/2012
Last updated
05/08/2012
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