Healthcare Provider Details

I. General information

NPI: 1073971453
Provider Name (Legal Business Name): COMPREHENSIVE ADDICTION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 W 1ST ST
SPRINGFIELD OH
45504-4264
US

IV. Provider business mailing address

484 S MILLER RD SUITE 201
FAIRLAWN OH
44333-4176
US

V. Phone/Fax

Practice location:
  • Phone: 937-322-8977
  • Fax: 937-322-5837
Mailing address:
  • Phone: 330-835-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MCDANIEL
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 330-835-4545