Healthcare Provider Details

I. General information

NPI: 1215690151
Provider Name (Legal Business Name): REGROWTH OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 PHILLIPS AVE BLDG E
TOLEDO OH
43612-1351
US

IV. Provider business mailing address

723 PHILLIPS AVE BLDG E
TOLEDO OH
43612-1351
US

V. Phone/Fax

Practice location:
  • Phone: 419-378-9212
  • Fax:
Mailing address:
  • Phone: 419-378-9212
  • Fax:

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TRYNA SANDERS
Title or Position: PRESIDENT
Credential:
Phone: 419-378-9212