Healthcare Provider Details

I. General information

NPI: 1699519199
Provider Name (Legal Business Name): 50 ST LAWRENCE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ST LAWRENCE DR
TIFFIN OH
44883-8310
US

IV. Provider business mailing address

60 HEMPSTEAD AVE STE 3005
WEST HEMPSTEAD NY
11552-2148
US

V. Phone/Fax

Practice location:
  • Phone: 567-207-2230
  • Fax:
Mailing address:
  • Phone: 347-728-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SCHAFFER
Title or Position: MANAGING MEMBER
Credential:
Phone: 347-728-8425