Healthcare Provider Details

I. General information

NPI: 1407326366
Provider Name (Legal Business Name): MIDWEST RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 MONROE ST
TOLEDO OH
43623-4307
US

IV. Provider business mailing address

10461 MILL RUN CIR STE 810
OWINGS MILLS MD
21117-5549
US

V. Phone/Fax

Practice location:
  • Phone: 866-203-0308
  • Fax:
Mailing address:
  • Phone: 832-240-3024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM BROWN
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 870-243-7219