Healthcare Provider Details

I. General information

NPI: 1447877147
Provider Name (Legal Business Name): OPEN WATER COUNSELING AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 NORTH RD SE
WARREN OH
44484-2907
US

IV. Provider business mailing address

1716 NORTH RD SE
WARREN OH
44484-2907
US

V. Phone/Fax

Practice location:
  • Phone: 330-539-3200
  • Fax: 330-529-5241
Mailing address:
  • Phone: 330-539-3200
  • Fax:

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: THOMAS R DEWEY
Title or Position: DIRECTOR/PRESIDENT
Credential: LPCC
Phone: 330-539-3200