Provider Demographics
NPI:1639894041
Name:SPAULDNG ADDICTION SERVICES
Entity Type:Organization
Organization Name:SPAULDNG ADDICTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-771-6387
Mailing Address - Street 1:1037 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2729
Mailing Address - Country:US
Mailing Address - Phone:740-360-7811
Mailing Address - Fax:740-383-6559
Practice Address - Street 1:2157 FIRSTENBERGER RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8792
Practice Address - Country:US
Practice Address - Phone:419-222-5077
Practice Address - Fax:740-205-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000314Medicaid
OH0267505Medicaid