Provider Demographics
NPI:1154547883
Name:GOODWILL EASTER SEALS MIAMI VALLEY
Entity type:Organization
Organization Name:GOODWILL EASTER SEALS MIAMI VALLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSCHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-461-4800
Mailing Address - Street 1:660 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2708
Mailing Address - Country:US
Mailing Address - Phone:937-461-4800
Mailing Address - Fax:937-461-9578
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-461-4800
Practice Address - Fax:937-461-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X, 251B00000X, 251C00000X, 251E00000X
OHS.12248156FX1800X, 332H00000X
OH01-0550251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1154547883Medicaid
OH2913646Medicaid
OH2284504Medicaid