Healthcare Provider Details

I. General information

NPI: 1821761081
Provider Name (Legal Business Name): ONE ME TO BE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 NEBRASKA AVE
TOLEDO OH
43607-3243
US

IV. Provider business mailing address

PO BOX 12571
TOLEDO OH
43606-0171
US

V. Phone/Fax

Practice location:
  • Phone: 419-318-8847
  • Fax:
Mailing address:
  • Phone: 419-318-8847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBIN GREEN
Title or Position: CO
Credential:
Phone: 419-297-2049