Organization
WILLARD DETOX OF OHIO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (CREDENTIALING MANAGER)
(443) 839-6928
Entity
Organization
Contact information
Practice address
725 WESSOR AVE, WILLARD, OH 44890-9417
(954) 415-3608
Mailing address
725 WESSOR AVE, WILLARD, OH 44890-9417
(954) 415-3608
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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