Provider Demographics
NPI:1497199079
Name:STATE LINE TREATMENT SERVICES, LLC
Entity Type:Organization
Organization Name:STATE LINE TREATMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:O
Authorized Official - Last Name:ERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-738-7600
Mailing Address - Street 1:120 MAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030
Mailing Address - Country:US
Mailing Address - Phone:513-335-3315
Mailing Address - Fax:513-738-7601
Practice Address - Street 1:120 MAY DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030
Practice Address - Country:US
Practice Address - Phone:513-335-3315
Practice Address - Fax:513-738-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health