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General NPI Number Information
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NPI Number | 1841034543
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Entity Type | Organization
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Legal Business Name | 690 COOPER ROAD OPS LLC
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 690 COOPER RD
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City | WESTERVILLE
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State | OH
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Zip | 43081-8900
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Country | US
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Telephone | 614-618-9834
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Fax | 866-422-8301
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Provider Business Mailing Address
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Address Line | 133 HOLIDAY CT STE 102
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City | FRANKLIN
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State | TN
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Zip | 37067-1386
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Country | US
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Telephone | 615-281-9050
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Fax |
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Authorized Official
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Title or Position | MANAGER, CRED & CONTRACTING
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Name | ALICIA NEAL
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Credential |
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Telephone | 615-281-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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