Provider Demographics
NPI:1811543671
Name:OHIO OPIATE RECOVERY
Entity Type:Organization
Organization Name:OHIO OPIATE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-571-5290
Mailing Address - Street 1:380 CLINE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1056
Mailing Address - Country:US
Mailing Address - Phone:419-571-5290
Mailing Address - Fax:419-522-0998
Practice Address - Street 1:380 CLINE AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1056
Practice Address - Country:US
Practice Address - Phone:419-571-5290
Practice Address - Fax:419-522-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty