Provider Demographics
NPI:1235729823
Name:VERTAVA HEALTH OUTPATIENT OHIO LLC
Entity Type:Organization
Organization Name:VERTAVA HEALTH OUTPATIENT OHIO LLC
Other - Org Name:VERTAVA HEALTH OUTPATIENT OHIO - ROCKY RIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-921-4447
Mailing Address - Street 1:PO BOX 90368
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-0368
Mailing Address - Country:US
Mailing Address - Phone:615-921-4447
Mailing Address - Fax:
Practice Address - Street 1:20575 CENTER RIDGE RD STE 400
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3422
Practice Address - Country:US
Practice Address - Phone:440-290-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERTAVA HEALTH OUTPATIENT OHIO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)