Healthcare Provider Details

I. General information

NPI: 1184169070
Provider Name (Legal Business Name): RED ZONE YOUNGSTOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HIGHLAND AVE
STRUTHERS OH
44471-2321
US

IV. Provider business mailing address

14 HIGHLAND AVE
STRUTHERS OH
44471-2321
US

V. Phone/Fax

Practice location:
  • Phone: 330-787-9180
  • Fax: 234-254-8890
Mailing address:
  • Phone: 330-787-9180
  • Fax: 234-254-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. DOMINIC GUY MANCINI
Title or Position: CEO
Credential: MBA
Phone: 330-307-3962