Healthcare Provider Details

I. General information

NPI: 1457858797
Provider Name (Legal Business Name): NORTH CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SOUTH ST
GREENFIELD OH
45123-1249
US

IV. Provider business mailing address

PO BOX 7
GREENFIELD OH
45123-0007
US

V. Phone/Fax

Practice location:
  • Phone: 405-053-3817
  • Fax: 937-462-1385
Mailing address:
  • Phone: 937-403-9108
  • Fax: 937-462-1385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLIE MARIE STEGALL
Title or Position: OWNER
Credential:
Phone: 937-403-9108