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General NPI Number Information
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NPI Number | 1568822633
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Entity Type | Organization
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Legal Business Name | LAND OF GOSHEN TREATMENT CENTER, INC
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 81 TOWNSHIP ROAD 349
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City | IRONTON
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State | OH
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Zip | 45638-8617
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Country | US
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Telephone | 740-449-7875
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Fax |
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Provider Business Mailing Address
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Address Line | 81 TOWNSHIP ROAD 349
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City | IRONTON
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State | OH
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Zip | 45638-8617
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Country | US
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Telephone | 740-449-7875
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | AMY SMITH
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Credential |
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Telephone | 740-442-7875
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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 |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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