MIDWEST DETOX CENTER LLC NPI 1356903058

NPI Information

NPI: 1356903058
Provider Name: MIDWEST DETOX CENTER LLC

Doing Business As: OHIO DETOX CENTER, LLC

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 36D2232079

Address:
1757 INDIAN WOOD CIR
MAUMEE, OH
ZIP 43537
Phone: (833) 440-8642
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MIDWEST DETOX CENTER LLC is a substance abuse rehabilitation facility in Maumee, OH. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. MIDWEST DETOX CENTER LLC NPI is 1356903058. The provider is registered as an organization entity type.
The provider Is Doing Business As Ohio Detox Center, Llc.

The provider's business location address is:

1757 INDIAN WOOD CIR
MAUMEE, OH
ZIP 43537-009
Phone: (833) 440-8642

The provider's authorized official is Allison Heaberlin .
The authorized official title is Credentialing Specialist and has the following contact phone number (410) 415-3385.

The CLIA number assigned to this NPI record is 36D2232079 - other - substance abuse residenti with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2019 and was last updated on 1/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0281740	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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