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NPI Code Detail

MEDICARE: GENESIS RECOVERY AND WELLNESS OF OHIO

MEDICARE: GENESIS RECOVERY AND WELLNESS OF OHIO
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1114637691
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS RECOVERY AND WELLNESS OF OHIO
Provider Business Mailing Address
First Line : 18051 JEFFERSON PARK RD STE 106
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3460
Country : US
Telephone Number : 330-443-0389
Fax Number :
Provider Business Practice Location Address
First Line : 18051 JEFFERSON PARK RD STE 106
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3460
Country : US
Telephone Number : 330-443-0389
Fax Number :
Authorized Official
Title or Position : CEO
Name : MITCHELL OZERI
Credential :
Telephone Number : 516-528-5115
Provider Enumeration Date : 11/25/2022
Last Update Date : 12/16/2022

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Directions to “GENESIS RECOVERY AND WELLNESS OF OHIO ” Practice Location

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