Basic Information
| Provider Information | |||||||||
| NPI: | 1184687030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAK RIDGE TREATMENT CENTER ACQ CORP | ||||||||
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| OtherOrganizationName: | OAK RIDGE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26456 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462260456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175246360 | ||||||||
| FaxNumber: | 3175444355 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 PRIVATE ROAD 977 COUNTY ROAD 44 NORTH | ||||||||
| Address2: | |||||||||
| City: | PEDRO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405341386 | ||||||||
| FaxNumber: | 7405341497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JAGODITZ | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3175246360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 052002 | OH | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 052003 | OH | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 052004 | OH | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 322D00000X | 052001 | OH | Y | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children |
No ID Information.