Provider Demographics
NPI:1003116344
Name:CHILLICOTHE ACUTE CARE CLINIC, INC.
Entity Type:Organization
Organization Name:CHILLICOTHE ACUTE CARE CLINIC, INC.
Other - Org Name:ANCHOR ADDICTION AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-726-9605
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70459-0160
Mailing Address - Country:US
Mailing Address - Phone:198-572-6960
Mailing Address - Fax:985-726-9633
Practice Address - Street 1:3 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8603
Practice Address - Country:US
Practice Address - Phone:740-779-6614
Practice Address - Fax:740-779-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01-7606261QR0405X, 261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271632Medicaid