Healthcare Provider Details

I. General information

NPI: 1285143594
Provider Name (Legal Business Name): BRYANS TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6648 SOUTH AVE
HOLLAND OH
43528
US

IV. Provider business mailing address

6648 SOUTH AVE
HOLLAND OH
43528-9507
US

V. Phone/Fax

Practice location:
  • Phone: 14194508273
  • Fax:
Mailing address:
  • Phone: 14194508273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number201726803838
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number201726803838
License Number StateOH

VIII. Authorized Official

Name: TERESA NICKOLE DENNIS
Title or Position: CEO
Credential: CDCA, RA
Phone: 419-450-8273