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General NPI Number Information
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NPI Number | 1295167757
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Entity Type | Organization
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Legal Business Name | HEALING TRAILS, LLC
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 4317 STATE ROUTE 269 S
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City | CASTALIA
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State | OH
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Zip | 44824-9354
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Country | US
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Telephone | 419-684-9750
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Fax |
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Provider Business Mailing Address
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Address Line | 143 COUNTY ROAD 242
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City | FREMONT
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State | OH
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Zip | 43420-9234
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Country | US
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Telephone | 419-552-0647
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | CARRIE TORRES
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Credential | LCDCIII
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Telephone | 419-552-0647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 111018
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License Number State | OH
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