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General NPI Number Information
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NPI Number | 1881274397
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Entity Type | Organization
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Legal Business Name | VERTAVA HEALTH OUTPATIENT OHIO LLC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 23600 COMMERCE PARK STE C
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City | BEACHWOOD
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State | OH
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Zip | 44122-5817
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Country | US
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Telephone | 615-921-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 205 REIDHURST AVE
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City | NASHVILLE
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State | TN
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Zip | 37203-1618
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Country | US
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Telephone | 615-921-4447
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Fax | 615-921-4447
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Authorized Official
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Title or Position | CONTROLLER
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Name | LEIGH ANN THOMPSON
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Credential |
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Telephone | 615-921-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health 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 | 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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