Healthcare Provider Details

I. General information

NPI: 1528411097
Provider Name (Legal Business Name): RACING FOR RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 TRUST DR
HOLLAND OH
43528-8425
US

IV. Provider business mailing address

6202 TRUST DR
HOLLAND OH
43528-8425
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-8462
  • Fax: 419-517-0514
Mailing address:
  • Phone: 419-824-8462
  • Fax: 419-517-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1252124
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1252124
License Number StateOH

VIII. Authorized Official

Name: TODD P CRANDELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-824-8462