Healthcare Provider Details

I. General information

NPI: 1881274397
Provider Name (Legal Business Name): VERTAVA HEALTH OUTPATIENT OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 COMMERCE PARK STE C
BEACHWOOD OH
44122-5817
US

IV. Provider business mailing address

205 REIDHURST AVE
NASHVILLE TN
37203-1618
US

V. Phone/Fax

Practice location:
  • Phone: 615-921-4447
  • Fax:
Mailing address:
  • Phone: 615-921-4447
  • Fax: 615-921-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN THOMPSON
Title or Position: CONTROLLER
Credential:
Phone: 615-921-4447