Provider Demographics
NPI:1659179802
Name:MEDINA CENTER OF HEALING LLC
Entity type:Organization
Organization Name:MEDINA CENTER OF HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:513-618-6528
Mailing Address - Street 1:11427 REED HARTMAN HWY # 105
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2418
Mailing Address - Country:US
Mailing Address - Phone:513-618-6528
Mailing Address - Fax:888-784-6795
Practice Address - Street 1:11427 REED HARTMAN HWY # 105
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2418
Practice Address - Country:US
Practice Address - Phone:513-618-6528
Practice Address - Fax:888-784-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty