Healthcare Provider Details

I. General information

NPI: 1720046451
Provider Name (Legal Business Name): RECOVERY SERVICES OF NORTHWEST OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 PERRY ST
DEFIANCE OH
43512-2123
US

IV. Provider business mailing address

511 PERRY ST
DEFIANCE OH
43512-2123
US

V. Phone/Fax

Practice location:
  • Phone: 419-782-9920
  • Fax: 419-784-2523
Mailing address:
  • Phone: 419-782-9920
  • Fax: 419-784-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1140,1975,1297,0989,
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number10998,3069,6686
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1140,1975,1297,0989
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number3069,6686
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1140,1975,1297,0989
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3069,6686
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1140,1975,1297,0989
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3069,6686
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1140,1975,1297,0989
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number3069,6686
License Number StateOH

VIII. Authorized Official

Name: RUTH PECK
Title or Position: CEO
Credential:
Phone: 419-782-9920