NPIMap

Organization Active NPI

Amazing Grace Treatment Center, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Dayton, OH
National Provider Identifier
1043057482
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
AMAZING GRACE TREATMENT CENTER, INC.
Practice address
17 Indiana Ave
Dayton, OH 45410-2307
Phone
(937) 640-3400
NPI assigned
Jul 12, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tyes'a Nelloms, ADN, QMHSNPI 1063041309
Title
Program Manager
Phone
(937) 231-8773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

17 Indiana Ave
Dayton, OH 45410-2307

Mailing address

17 Indiana Ave
Dayton, OH 45410-2307
Phone (937) 640-3400

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL TherapyNotes Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774224000000",
    "number": "1043057482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 INDIANA AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102307",
            "telephone_number": "937-640-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 INDIANA AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454102307",
            "telephone_number": "937-640-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMAZING GRACE TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-12",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A",
        "authorized_official_last_name": "NELLOMS",
        "authorized_official_first_name": "TYES'A",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "937-231-8773",
        "authorized_official_credential": "ADN, QMHS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "TherapyNotes",
            "affiliation": "N",
            "endpointDescription": "Electronic Health Records",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "17 Indiana Ave",
            "city": "Dayton",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454102307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.