NPIMap

Organization Active NPI

Dayton Veterans Affairs Medical Center

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Kettering, OH
National Provider Identifier
1417037268
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X
License
S-0016717 Issued in OH
Legal business name
DAYTON VETERANS AFFAIRS MEDICAL CENTER
Practice address
3547 Far Hills Ave
Kettering, OH 45429-2501
Phone
(937) 293-7484
NPI assigned
Oct 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Mario Mancini Jr., CRCNPI 1851476048
Title
Vocational Rehabilitation Specialis
Phone
(937) 268-6511

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Hospital Unit 276400000X S-0016717 OH Primary

Addresses

Primary practice location

3547 Far Hills Ave
Kettering, OH 45429-2501

Mailing address

3547 Far Hills Ave
Kettering, OH 45429-2501
Phone (937) 293-7484

Other identifiers 1

IdentifierTypeStateIssuer
00016730OtherOHCERTIFICATION

National Provider Directory

National Provider Directory
Tax ID family
Dayton Vamc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417037268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3547 FAR HILLS AVE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292501",
            "telephone_number": "937-293-7484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3547 FAR HILLS AVE",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454292501",
            "telephone_number": "937-293-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYTON VETERANS AFFAIRS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANCINI",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "VOCATIONAL REHABILITATION SPECIALIS",
        "authorized_official_telephone_number": "937-268-6511",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CRC"
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "OH",
            "license": "S-0016717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATION",
            "identifier": "00016730",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.