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General NPI Number Information
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NPI Number | 1285143594
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Entity Type | Organization
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Legal Business Name | BRYANS TREATMENT CENTER
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 6648 SOUTH AVE
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City | HOLLAND
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State | OH
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Zip | 43528
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Country | US
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Telephone | 14194508273
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Fax |
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Provider Business Mailing Address
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Address Line | 6648 SOUTH AVE
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City | HOLLAND
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State | OH
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Zip | 43528-9507
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Country | US
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Telephone | 14194508273
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERESA NICKOLE DENNIS
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Credential | CDCA, RA
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Telephone | 419-450-8273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 201726803838
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | 201726803838
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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