Provider Demographics
NPI:1881274397
Name:VERTAVA HEALTH OUTPATIENT OHIO LLC
Entity type:Organization
Organization Name:VERTAVA HEALTH OUTPATIENT OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
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:615-921-4447
Mailing Address - Fax:615-921-4447
Practice Address - Street 1:23600 COMMERCE PARK STE C
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5817
Practice Address - Country:US
Practice Address - Phone:615-921-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERTAVA HEALTH OUTPATIENT OHIO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health