MEDICARE: ALCHEMY INTERVENTION SERVICES INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist
3	251B00000X	Case Management Agency
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1215399944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALCHEMY INTERVENTION SERVICES INC

Provider Business Mailing Address
First Line	:	2180 ROMIG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3879
Country	:	US
Telephone Number	:	330-745-5488
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 ROMIG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3879
Country	:	US
Telephone Number	:	330-745-5488
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE ABUSE THERAPIST
Name	:	BERNARD DAMON TAYLOR
Credential	:	LICDC
Telephone Number	:	330-745-5488

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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Directions to “ALCHEMY INTERVENTION SERVICES INC ” Practice Location

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