Organization
UMATR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH ANTHONY VUKASINOVICH (CEO)
(937) 369-3020
Entity
Organization
Contact information
Practice address
519 XENIA AVE, DAYTON, OH 45410-1823
(937) 369-3020
Mailing address
201 W FRANKLIN ST STE B, CENTERVILLE, OH 45459-4700
(937) 369-3020
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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