Provider Demographics
NPI:1750141545
Name:RECOVERY SERVICES OF GREATER DAYTON LLP
Entity type:Organization
Organization Name:RECOVERY SERVICES OF GREATER DAYTON LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSTIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC II
Authorized Official - Phone:937-247-4717
Mailing Address - Street 1:3430 S DIXIE DR STE 308
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2316
Mailing Address - Country:US
Mailing Address - Phone:937-247-4717
Mailing Address - Fax:
Practice Address - Street 1:3430 S DIXIE DR STE 308
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2316
Practice Address - Country:US
Practice Address - Phone:937-247-4717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health