Organization
MOHICAN YOUTH ACADEMY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY BRUNO (CREDENTIALING)
(614) 556-4616
Entity
Organization
Contact information
Practice address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
(419) 994-0300
Mailing address
1012 ODNR MOHICAN 51, PERRYSVILLE, OH 44864-9407
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
13519
OH
Other
Enumeration date
05/29/2014
Last updated
01/22/2018
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