Provider Demographics
NPI:1780738567
Name:DARKE COUNTY RECOVERY SERVICES
Entity type:Organization
Organization Name:DARKE COUNTY RECOVERY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC-CS
Authorized Official - Phone:937-548-6842
Mailing Address - Street 1:600 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1944
Mailing Address - Country:US
Mailing Address - Phone:937-548-6842
Mailing Address - Fax:937-548-8938
Practice Address - Street 1:228 N BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-1704
Practice Address - Country:US
Practice Address - Phone:937-456-7694
Practice Address - Fax:937-456-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10652251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10652Medicare UPIN