Provider Demographics
NPI:1538560693
Name:DAYTON CORECTIONAL INSTITUTION
Entity type:Organization
Organization Name:DAYTON CORECTIONAL INSTITUTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORK SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:OFFUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MALICDC-CS
Authorized Official - Phone:937-263-0060
Mailing Address - Street 1:4104 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-6118
Mailing Address - Country:US
Mailing Address - Phone:937-263-0060
Mailing Address - Fax:937-263-1322
Practice Address - Street 1:4104 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-6118
Practice Address - Country:US
Practice Address - Phone:937-263-0060
Practice Address - Fax:937-263-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit