Provider Demographics
NPI:1790753200
Name:THE WAY STATION, INC.
Entity Type:Organization
Organization Name:THE WAY STATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLSOPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:330-385-7510
Mailing Address - Street 1:769 SPRINGFIELD RD
Mailing Address - Street 2:PO BOX 449
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-9456
Mailing Address - Country:US
Mailing Address - Phone:330-482-5072
Mailing Address - Fax:330-482-5074
Practice Address - Street 1:432 W FIFTH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2467
Practice Address - Country:US
Practice Address - Phone:330-385-7510
Practice Address - Fax:330-385-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111553245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11155Medicaid
OH11155Medicaid