Provider Demographics
NPI:1043277759
Name:CLERMONT RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:CLERMONT RECOVERY CENTER, INC.
Other - Org Name:COUNCIL ON ALCOHOLISM & DRUG ABUSE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOLDSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LICDC
Authorized Official - Phone:513-735-8100
Mailing Address - Street 1:1088 WASSERMAN WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1911
Mailing Address - Country:US
Mailing Address - Phone:513-735-8100
Mailing Address - Fax:513-735-8156
Practice Address - Street 1:1088 WASSERMAN WAY
Practice Address - Street 2:SUITE C
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1911
Practice Address - Country:US
Practice Address - Phone:513-735-8100
Practice Address - Fax:513-735-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3249Medicare UPIN
OH10454Medicare UPIN