Healthcare Provider Details

I. General information

NPI: 1043863384
Provider Name (Legal Business Name): TEAM RECOVERY OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 W SYLVANIA AVE
TOLEDO OH
43623-3463
US

IV. Provider business mailing address

4352 W SYLVANIA AVE
TOLEDO OH
43623-3463
US

V. Phone/Fax

Practice location:
  • Phone: 419-764-7201
  • Fax:
Mailing address:
  • Phone: 419-561-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BELL
Title or Position: CEO
Credential:
Phone: 419-764-7201