| Eastway Corporation | |
|
600 Wayne Ave Dayton OH 45410-1122 | |
| (937) 496-2000 | |
| (937) 463-2901 |
| Full Name | Eastway Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 600 Wayne Ave, Dayton, Ohio |
| Authorized Official Name and Position | Cybil Saum-johnson (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 9374962000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastway Corporation 600 Wayne Ave Dayton OH 45410-1122 Ph: () - | Eastway Corporation 600 Wayne Ave Dayton OH 45410-1122 Ph: (937) 496-2000 |
| NPI Number | 1811920556 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 07/17/2017 |
| Medicare PECOS PAC ID | 1153211065 |
|---|---|
| Medicare Enrollment ID | O20040316000785 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811920556 | NPI | - | NPPES |
| 0201758 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 1396 (Ohio) | Primary |
| Provider Name | Paul Francis Hanley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760507057 PECOS PAC ID: 4789657131 Enrollment ID: I20040816000055 |
| Provider Name | Bertilia M Toca |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457339582 PECOS PAC ID: 2466403324 Enrollment ID: I20050208000692 |
| Provider Name | Edward Charles Longo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194841510 PECOS PAC ID: 5496948101 Enrollment ID: I20101026000335 |
| Provider Name | Jeannine E Sheppard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720105109 PECOS PAC ID: 8628254240 Enrollment ID: I20110517000231 |
| Provider Name | Steven Taylor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235128281 PECOS PAC ID: 8022045665 Enrollment ID: I20110517000304 |
| Provider Name | Christopher John Hasseltine |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205809001 PECOS PAC ID: 5890723746 Enrollment ID: I20131025001248 |
| Provider Name | Robert Orgain Hardy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982791729 PECOS PAC ID: 3577573302 Enrollment ID: I20170810003804 |
| Provider Name | Dona Jean Blankenship |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205509916 PECOS PAC ID: 8224436076 Enrollment ID: I20211007002762 |
| Provider Name | Lisa Cherubini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871128884 PECOS PAC ID: 0941699136 Enrollment ID: I20211109002197 |
| Provider Name | Brandy Davina Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316452253 PECOS PAC ID: 2365831369 Enrollment ID: I20211112001470 |
| Provider Name | Katherine L. Lind |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386771897 PECOS PAC ID: 2062806870 Enrollment ID: I20220221001840 |
| Provider Name | Ashley Nicole Lucas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942710082 PECOS PAC ID: 7113388661 Enrollment ID: I20230731002055 |
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