Provider Demographics
NPI:1912094699
Name:HEALTHCARE VENTURE PARTNERS, LLC
Entity Type:Organization
Organization Name:HEALTHCARE VENTURE PARTNERS, LLC
Other - Org Name:NORTHLAND INTERVENTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LICD-CS, LPCC, NCC
Authorized Official - Phone:513-753-9964
Mailing Address - Street 1:25 WHITNEY DRIVE, SUITE 122
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150
Mailing Address - Country:US
Mailing Address - Phone:513-753-9964
Mailing Address - Fax:513-753-9968
Practice Address - Street 1:25 WHITNEY DRIVE, SUITE 122
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:513-753-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10698Medicaid