Organization
NEW DESTINY TREATMENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT W. BOLOIS PH.D., LICDC-CS (CEO)
(330) 825-5202
Entity
Organization
Contact information
Practice address
6694 TAYLOR RD, CLINTON, OH 44216-9201
(330) 825-5202
(330) 825-5113
Mailing address
6694 TAYLOR RD, CLINTON, OH 44216-9201
(330) 825-5202
(330) 825-5113
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
34.005720
OH
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0249609
—
OH
Enumeration date
01/21/2014
Last updated
12/27/2022
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