Healthcare Provider Details

I. General information

NPI: 1326973603
Provider Name (Legal Business Name): MANNAMENTAL ADDICTION AND RECOVERY CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 W ELM ST STE 300
LIMA OH
45805-2555
US

IV. Provider business mailing address

3101 W ELM ST STE 300
LIMA OH
45805-2555
US

V. Phone/Fax

Practice location:
  • Phone: 419-673-7754
  • Fax:
Mailing address:
  • Phone: 419-673-7754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL GASU
Title or Position: CEO
Credential: NP-C
Phone: 740-818-5248