Organization
AM4ZLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SA'JAE EVERHART LPN (OWNER)
(614) 290-0033
Entity
Organization
Contact information
Practice address
1958 BURROUGHS DR, DAYTON, OH 45406-4418
(614) 290-0033
Mailing address
1958 BURROUGHS DR, DAYTON, OH 45406-4418
(614) 290-0033
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/03/2023
Last updated
08/03/2023
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