1538830351 NPI number — LIFE AFTER ADDICTION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538830351 NPI number — LIFE AFTER ADDICTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE AFTER ADDICTION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538830351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9079 CRANBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44067-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
234-380-7557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 HIGHLAND RD E UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACEDONIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44056-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-468-5050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VANA
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
234-380-7557

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)