Healthcare Provider Details

I. General information

NPI: 1730594219
Provider Name (Legal Business Name): MENDED REEDS SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK AVE
IRONTON OH
45638-1502
US

IV. Provider business mailing address

PO BOX 108
IRONTON OH
45638-0108
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1613
  • Fax: 740-532-1715
Mailing address:
  • Phone: 740-532-6220
  • Fax: 740-532-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0588
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0588
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBBIE HIXON
Title or Position: OFFICE MANAGER
Credential:
Phone: 740-532-6220