Healthcare Provider Details

I. General information

NPI: 1811379845
Provider Name (Legal Business Name): PRIMARY CARE SOLUTIONS OF OHIO INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE SUITE 300
TOLEDO OH
43604-1222
US

IV. Provider business mailing address

5700 EXECUTIVE CENTER DR SUITE 101
CHARLOTTE NC
28212-8858
US

V. Phone/Fax

Practice location:
  • Phone: 888-380-9990
  • Fax: 888-380-9990
Mailing address:
  • Phone: 888-380-9990
  • Fax: 888-380-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLYNE ROUNDTREE
Title or Position: MANAGING PARTNER
Credential:
Phone: 888-380-9990