MEDICARE: SUBSTANCE ABUSE SERVICES, INC.

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	261QM2800X	Methadone Clinic	NOT APPLICABLE	OH

General Provider Information

NPI Number	:	1386607067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBSTANCE ABUSE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1832 ADAMS ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43624-1428
Country	:	US
Telephone Number	:	419-241-8827
Fax Number	:	419-321-6834

Provider Business Practice Location Address
First Line	:	1832 ADAMS ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43624-1428
Country	:	US
Telephone Number	:	419-241-8827
Fax Number	:	419-321-6834

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. WILLIAM SANFORD
Credential	:
Telephone Number	:	419-241-8827

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/21/2022

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