Organization
SQUARE ONE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN D DUFOUR (OWNER)
(928) 231-1789
Entity
Organization
Contact information
Practice address
620 W 44TH ST, ASHTABULA, OH 44004-6812
(602) 736-6973
Mailing address
620 W 44TH ST, ASHTABULA, OH 44004-6812
(602) 736-6973
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
01/25/2019
Last updated
09/07/2021
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