Healthcare Provider Details

I. General information

NPI: 1215933569
Provider Name (Legal Business Name): CONSOLIDATED CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 N DETROIT ST
WEST LIBERTY OH
43357-9794
US

IV. Provider business mailing address

PO BOX 817
WEST LIBERTY OH
43357-0817
US

V. Phone/Fax

Practice location:
  • Phone: 937-465-8065
  • Fax: 937-465-0442
Mailing address:
  • Phone: 937-465-8065
  • Fax: 937-465-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDELL R REMINDER
Title or Position: PRESIDENT
Credential: LPCC
Phone: 937-465-8065