Healthcare Provider Details

I. General information

NPI: 1316859986
Provider Name (Legal Business Name): MANNAMENTAL ADDICTION AND RECOVERY CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
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: 567-712-7060
Mailing address:
  • Phone: 419-673-7754
  • Fax: 567-712-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL GASU
Title or Position: MANAGER
Credential:
Phone: 740-818-5248