Provider Demographics
NPI:1649794884
Name:NORTH DAYTON ADDICTION & RECOVERY, LLC
Entity type:Organization
Organization Name:NORTH DAYTON ADDICTION & RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODZIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-416-5442
Mailing Address - Street 1:117 S DIXIE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2142
Mailing Address - Country:US
Mailing Address - Phone:937-416-5442
Mailing Address - Fax:
Practice Address - Street 1:117 S DIXIE DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-416-5442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center