Provider Demographics
NPI:1669885265
Name:FOSTORIA ALCOHOL/DRUG CENTER
Entity type:Organization
Organization Name:FOSTORIA ALCOHOL/DRUG CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS/SAP/ICCS
Authorized Official - Phone:419-435-9465
Mailing Address - Street 1:222 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2321
Mailing Address - Country:US
Mailing Address - Phone:419-435-9465
Mailing Address - Fax:419-435-0493
Practice Address - Street 1:222 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2321
Practice Address - Country:US
Practice Address - Phone:419-435-9465
Practice Address - Fax:419-435-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty