Provider Demographics
NPI:1528411097
Name:RACING FOR RECOVERY
Entity Type:Organization
Organization Name:RACING FOR RECOVERY
Other - Org Name:RACING FOR RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-824-8462
Mailing Address - Street 1:6202 TRUST DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8425
Mailing Address - Country:US
Mailing Address - Phone:419-824-8462
Mailing Address - Fax:419-517-0514
Practice Address - Street 1:6202 TRUST DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8425
Practice Address - Country:US
Practice Address - Phone:419-824-8462
Practice Address - Fax:419-517-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
OH1252124251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management