Organization
MONTGOMERY COUNTY BOARD OF MR/DD
Active
Organization
MONTGOMERY COUNTY BOARD OF MR/DD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PROULX (DIRECTOR OF FINANCIAL MANAGEMENT)
(937) 837-9258
Entity
Organization
Contact information
Practice address
5450 SALEM AVE, DAYTON, OH 45426-1450
(937) 837-9200
(937) 854-0492
Mailing address
5450 SALEM AVE, DAYTON, OH 45426-1450
(937) 837-9200
(937) 854-0492
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0880337
—
OH
05
—
2568994
—
OH
05
—
2741295
—
OH
Enumeration date
10/12/2006
Last updated
04/16/2012
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