| Organization Name: | 88 MDOS |
| NPI Number: | 1124206594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RANDON WELTON (PROGRAM DIRECTOR) |
| Mailing Address: | 88 Sugar Maple Dr. Wpafb |
| State: | OH US |
| Postal Code: | 45433 |
| Phone Number: | 9372571363 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2008 |
| NPI Last Update Date: | 02/07/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0850X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Mental Health |
| Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |