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General NPI Number Information
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NPI Number | 1073971453
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ADDICTION SERVICES, LLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 02/01/2016
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Provider Practice Location Address
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Address Line | 2816 W 1ST ST
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City | SPRINGFIELD
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State | OH
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Zip | 45504-4264
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Country | US
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Telephone | 937-322-8977
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Fax | 937-322-5837
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Provider Business Mailing Address
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Address Line | 484 S MILLER RD SUITE 201
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City | FAIRLAWN
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State | OH
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Zip | 44333-4176
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Country | US
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Telephone | 330-835-4545
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MATTHEW MCDANIEL
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Credential | MD
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Telephone | 330-835-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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