INTERVAL BROTHERHOOD HOMES INC. NPI 1760576565

NPI Information

NPI: 1760576565
Provider Name: INTERVAL BROTHERHOOD HOMES, INC.
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
:
CLIA Number: 36D0941418
Address: 3445 S MAIN ST
COVENTRY TWP, OH
ZIP 44319
Phone: (330) 644-4095

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NPI Details

INTERVAL BROTHERHOOD HOMES, INC. is a substance abuse rehabilitation facility in Coventry Twp, 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. INTERVAL BROTHERHOOD HOMES, INC. NPI is 1760576565. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

3445 S MAIN ST
COVENTRY TWP, OH
ZIP 44319-028
Phone: (330) 644-4095
Fax: (330) 645-2031

The provider's authorized official is Anthony Henderson .
The authorized official title is Cfo and has the following contact phone number (330) 237-6878.

The CLIA number assigned to this NPI record is 36D0941418 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 4/23/2025.

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	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			No
3	320800000X	Community Based Residential Treatment Facility, Mental Illness				No
4	324500000X	Substance Abuse Rehabilitation Facility		1505	OHIO	Yes

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: 11/21/2025

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