MEDICARE: TEAM RECOVERY OHIO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1043863384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM RECOVERY OHIO, LLC

Provider Business Mailing Address
First Line	:	4352 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3463
Country	:	US
Telephone Number	:	419-561-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4352 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43623-3463
Country	:	US
Telephone Number	:	419-764-7201
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MATTHEW BELL
Credential	:
Telephone Number	:	419-764-7201

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	08/22/2024

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