Healthcare Provider Details

I. General information

NPI: 1225220593
Provider Name (Legal Business Name): DIRECTIONS OFFENDER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W MAIN ST
CARDINGTON OH
43315-1009
US

IV. Provider business mailing address

104 W. MAIN ST. PO BOX 254
CARDINGTON OH
43315
US

V. Phone/Fax

Practice location:
  • Phone: 419-864-0023
  • Fax:
Mailing address:
  • Phone: 419-864-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL KENNETH SHEARS
Title or Position: CEO,PRESIDENT
Credential: CCDC1
Phone: 419-864-0023