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NPI Code Detail

MEDICARE: 50 ST LAWRENCE OPCO LLC

MEDICARE: 50 ST LAWRENCE OPCO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric Hospital

General Provider Information

NPI Number : 1831068816
Entity Type Code : Organization
Provider Name (Legal Business Name) : 50 ST LAWRENCE OPCO LLC
Provider Business Mailing Address
First Line : 50 ST LAWRENCE DR
Second Line :
City : TIFFIN
State : OH
Zip : 44883-8310
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 ST LAWRENCE DR
Second Line :
City : TIFFIN
State : OH
Zip : 44883-8310
Country : US
Telephone Number : 567-207-2230
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : DANIEL S
Credential :
Telephone Number : 347-728-8425
Provider Enumeration Date : 10/30/2025
Last Update Date : 02/03/2026

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Directions to “50 ST LAWRENCE OPCO LLC ” Practice Location

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