Provider Demographics
NPI:1184687030
Name:OAK RIDGE TREATMENT CENTER ACQ CORP
Entity Type:Organization
Organization Name:OAK RIDGE TREATMENT CENTER ACQ CORP
Other - Org Name:OAK RIDGE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGODITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-524-6360
Mailing Address - Street 1:PO BOX 26456
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-0456
Mailing Address - Country:US
Mailing Address - Phone:317-524-6360
Mailing Address - Fax:317-544-4355
Practice Address - Street 1:115 PRIVATE ROAD 977 COUNTY ROAD 44 NORTH
Practice Address - Street 2:
Practice Address - City:PEDRO
Practice Address - State:OH
Practice Address - Zip Code:45659
Practice Address - Country:US
Practice Address - Phone:740-534-1386
Practice Address - Fax:740-534-1497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052001322D00000X
OH052002322D00000X
OH052003322D00000X
OH052004322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children