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NPI Code Detail

MEDICARE: NORTH CREEK LLC

MEDICARE: NORTH CREEK 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1457858797
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH CREEK LLC
Provider Business Mailing Address
First Line : PO BOX 7
Second Line :
City : GREENFIELD
State : OH
Zip : 45123-0007
Country : US
Telephone Number : 937-403-9108
Fax Number : 937-462-1385
Provider Business Practice Location Address
First Line : 910 SOUTH ST
Second Line :
City : GREENFIELD
State : OH
Zip : 45123-1249
Country : US
Telephone Number : 405-053-3817
Fax Number : 937-462-1385
Authorized Official
Title or Position : OWNER
Name : LESLIE MARIE STEGALL
Credential :
Telephone Number : 937-403-9108
Provider Enumeration Date : 04/12/2018
Last Update Date : 06/26/2025

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Directions to “NORTH CREEK LLC ” Practice Location

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