Healthcare Provider Details

I. General information

NPI: 1780330688
Provider Name (Legal Business Name): AWARE RECOVERY CARE OF OHIO,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131-2581
US

IV. Provider business mailing address

35 THORPE AVE STE 104
WALLINGFORD CT
06492-1948
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax:
Mailing address:
  • Phone: 203-640-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAUREN GRAWERT
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 203-779-5799