Basic Information
| Provider Information | |||||||||
| NPI: | 1720046451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECOVERY SERVICES OF NORTHWEST OHIO, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 PERRY ST | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197829920 | ||||||||
| FaxNumber: | 4197842523 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 PERRY ST | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197829920 | ||||||||
| FaxNumber: | 4197842523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | PECK | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4197829920 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 3069,6686 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | 251300000X | 1140,1975,1297,0989, | OH | N | Agencies | Local Education Agency (LEA) | 251300000X | 10998,3069,6686 | N | Agencies | Local Education Agency (LEA) | 251B00000X | 1140,1975,1297,0989 | OH | N | Agencies | Case Management | 251B00000X | 3069,6686 | OH | N | Agencies | Case Management | 261QM0801X | 1140,1975,1297,0989 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | 3069,6686 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QR0405X | 1140,1975,1297,0989 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QR0405X | 3069,6686 | OH | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261Q00000X | 1140,1975,1297,0989 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 2846906 | 05 | OH | MEDICAID | 1140 | 01 | OH | MACSIS UPI | OTHER |