Organization
SELF EMPLOYEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANIA MONIQUE MCCLESKEY (LPN)
(937) 516-7887
Entity
Organization
Contact information
Practice address
3053 NICHOLAS RD, DAYTON, OH 45417-4322
(937) 516-7887
Mailing address
3053 NICHOLAS RD, DAYTON, OH 45417-4322
(937) 516-7887
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
PN134284IV
OH
Other
Enumeration date
11/12/2009
Last updated
03/06/2013
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