Organization
TEHG, LLC
Active
Other names
The Ellis House Group
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BONIEN SUE RODRIGUEZ (COO)
(419) 277-9843
Entity
Organization
Contact information
Practice address
40 S 2ND ST, WATERVILLE, OH 43566-1407
(419) 277-9843
(419) 710-8558
Mailing address
40 S 2ND ST, WATERVILLE, OH 43566-1407
(419) 277-9843
(419) 710-8558
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
H483460
OH
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0180404
—
OH
Enumeration date
05/20/2018
Last updated
05/20/2018
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