Provider Demographics
NPI:1033111406
Name:YOUNGSTOWN COMMITTEE ON ALCOHOLISM INC
Entity Type:Organization
Organization Name:YOUNGSTOWN COMMITTEE ON ALCOHOLISM INC
Other - Org Name:NEIL KENNEDY RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-604-8900
Mailing Address - Street 1:311 ROUSER RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-6801
Mailing Address - Country:US
Mailing Address - Phone:330-744-1181
Mailing Address - Fax:330-740-2849
Practice Address - Street 1:2151 RUSH BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1535
Practice Address - Country:US
Practice Address - Phone:330-744-1181
Practice Address - Fax:330-740-2849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNGSTOWN COMMITTEE ON ALCOHOLISM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01365261QR0405X, 324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2877507Medicaid
OH01-7688OtherFACILITY LICENSE