Provider Demographics
NPI:1942785233
Name:OLD RIVER ASSOCIATES LLC
Entity Type:Organization
Organization Name:OLD RIVER ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TAX ID OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NASSIF
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:440-668-5496
Mailing Address - Street 1:19035 OLD DETROIT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1750
Mailing Address - Country:US
Mailing Address - Phone:440-668-5496
Mailing Address - Fax:
Practice Address - Street 1:19035 OLD DETROIT RD STE 201
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1750
Practice Address - Country:US
Practice Address - Phone:440-668-5496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty