=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457858797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CREEK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2018
-----------------------------------------------------
Last Update Date | 06/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 SOUTH ST
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-053-3817
-----------------------------------------------------
Fax | 937-462-1385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7
-----------------------------------------------------
City | GREENFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45123-0007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-403-9108
-----------------------------------------------------
Fax | 937-462-1385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LESLIE MARIE STEGALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-403-9108
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------