Healthcare Provider Details

I. General information

NPI: 1922717685
Provider Name (Legal Business Name): TALBOT CLINICAL SERVICES OF OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 MAIN ST
TOLEDO OH
43605-2397
US

IV. Provider business mailing address

732 MAIN ST
TOLEDO OH
43605-2397
US

V. Phone/Fax

Practice location:
  • Phone: 833-762-1013
  • Fax: 419-691-0601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ELAINE WILSON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 281-962-8878