Individual
MICHELLE NEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6374 ELK CREEK RD, MIDDLETOWN, OH 45042-8921
(513) 504-6979
Mailing address
917 HARTZ DR, LEBANON, OH 45036-1325
(513) 504-6979
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0245289
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0245289
—
OH
01
—
8304801
DODD CONTRACT #
OH
Enumeration date
11/08/2017
Last updated
11/08/2017
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