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General NPI Number Information
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NPI Number | 1528457991
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Entity Type | Organization
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Legal Business Name | THE RADEBAUGH LLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 02/14/2015
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Provider Practice Location Address
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Address Line | 18240 ROYALTON RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-5181
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Country | US
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Telephone | 440-580-4520
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Fax |
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Provider Business Mailing Address
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Address Line | 6015 BRAYMOORE DR
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City | GALENA
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State | OH
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Zip | 43021-9093
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Country | US
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Telephone | 614-374-0389
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Fax | 740-879-4577
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Authorized Official
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Title or Position | OWNER
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Name | JAMES B RADEBAUGH
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Credential |
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Telephone | 614-374-0389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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