Provider Demographics
NPI:1114323102
Name:MIDDLETOWN HOSLITIC OUTREACH CENTER LLC
Entity Type:Organization
Organization Name:MIDDLETOWN HOSLITIC OUTREACH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWRNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VARONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-260-9643
Mailing Address - Street 1:1217 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-5829
Mailing Address - Country:UM
Mailing Address - Phone:513-260-9643
Mailing Address - Fax:
Practice Address - Street 1:1217 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5829
Practice Address - Country:US
Practice Address - Phone:513-260-9643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility