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General NPI Number Information
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NPI Number | 1326070160
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Entity Type | Organization
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Legal Business Name | MANSFIELD UMADAOP, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 BOWMAN ST
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City | MANSFIELD
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State | OH
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Zip | 44903-1235
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Country | US
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Telephone | 419-525-3535
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Fax | 419-525-3538
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Provider Business Mailing Address
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Address Line | 400 BOWMAN ST P.O. BOX 1316
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City | MANSFIELD
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State | OH
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Zip | 44903-1235
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Country | US
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Telephone | 419-525-3535
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Fax | 419-525-3538
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. GERON TATE
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Credential | ICDC/OCPSII
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Telephone | 419-525-3531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | OH
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