Provider Demographics
NPI:1124597182
Name:SILVER MAPLE RECOVERY, LLC
Entity Type:Organization
Organization Name:SILVER MAPLE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIEDENMANNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5238
Mailing Address - Street 1:3905 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2853
Mailing Address - Country:US
Mailing Address - Phone:440-989-5238
Mailing Address - Fax:440-989-4362
Practice Address - Street 1:2101 SILVER MAPLE WAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2380
Practice Address - Country:US
Practice Address - Phone:440-830-3400
Practice Address - Fax:440-830-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder