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General NPI Number Information
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NPI Number | 1487913539
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Entity Type | Organization
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Legal Business Name | COMMUNITY COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 2458 STETZER RD
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City | BUCYRUS
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State | OH
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Zip | 44820-2066
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Country | US
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Telephone | 419-562-2000
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Fax | 419-562-1296
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Provider Business Mailing Address
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Address Line | 2458 STETZER RD P.O. BOX 765
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City | BUCYRUS
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State | OH
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Zip | 44820-2066
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Country | US
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Telephone | 419-562-2000
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Fax | 419-562-1296
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. THOMAS J SACCENTI
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Credential |
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Telephone | 419-562-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 0177
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License Number State | OH
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