Provider Demographics
NPI:1255950739
Name:ADDICTION CAMPUSES PROFESSIONAL SERVICES OF OHIO, LLC
Entity type:Organization
Organization Name:ADDICTION CAMPUSES PROFESSIONAL SERVICES OF OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-921-4447
Mailing Address - Street 1:205 REIDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 LODGE RD SW
Practice Address - Street 2:
Practice Address - City:SHERRODSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44675-9718
Practice Address - Country:US
Practice Address - Phone:330-866-0916
Practice Address - Fax:330-556-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty