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General NPI Number Information
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NPI Number | 1811543671
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Entity Type | Organization
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Legal Business Name | OHIO OPIATE RECOVERY
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 380 CLINE AVE STE 1
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City | MANSFIELD
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State | OH
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Zip | 44907-1056
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Country | US
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Telephone | 419-571-5290
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Fax | 419-522-0998
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Provider Business Mailing Address
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Address Line | 380 CLINE AVE STE 1
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City | MANSFIELD
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State | OH
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Zip | 44907-1056
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Country | US
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Telephone | 419-571-5290
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Fax | 419-522-0998
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STACEY RENEE WOLFE
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Credential |
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Telephone | 419-571-5290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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