MEDICARE: OHIO BEHAVIORAL DIVERSION & TREATMENT CENTER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366121386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO BEHAVIORAL DIVERSION & TREATMENT CENTER

Provider Business Mailing Address
First Line	:	2140 WYNDHURST RD APT 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1388
Country	:	US
Telephone Number	:	567-297-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 WYNDHURST RD APT 2
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-1388
Country	:	US
Telephone Number	:	567-297-9621
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. BRADLEY HIGGS
Credential	:	LSW, LCDC III
Telephone Number	:	567-203-3375

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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