Provider Demographics
NPI:1902408321
Name:COSHOCTON COUNTY RECOVERY LLC
Entity Type:Organization
Organization Name:COSHOCTON COUNTY RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:740-861-1704
Mailing Address - Street 1:537 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1628
Mailing Address - Country:US
Mailing Address - Phone:740-693-4113
Mailing Address - Fax:
Practice Address - Street 1:537 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1628
Practice Address - Country:US
Practice Address - Phone:740-693-4113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder