Organization
OHIO GROUP HOME OF MIDDLETOWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LAURDERDALE (MANAGER)
(845) 205-6813
Entity
Organization
Contact information
Practice address
3100 S MAIN ST, MIDDLETOWN, OH 45044-7421
(845) 205-6813
Mailing address
1 EXECUTIVE BLVD STE 203, SUFFERN, NY 10901-4157
(845) 205-6813
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/03/2022
Last updated
03/03/2022
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