NPIMap

Organization Active NPI

Wolf Creek Wellness LLC

  • Addiction (Substance Use Disorder) Counselor
  • Wadsworth, OH
National Provider Identifier
1003355090
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
34.009421 Issued in OH
Legal business name
WOLF CREEK WELLNESS LLC
Practice address
680 High St Ste a
Wadsworth, OH 44281-1690
Phone
(306) 902-3373
Fax
(330) 822-6955
NPI assigned
Feb 23, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard MaroonNPI 1861678849
Title
Clinical Director
Phone
(330) 690-2337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 34.009421 OH Primary

Addresses

Primary practice location

680 High St Ste a
Wadsworth, OH 44281-1690

Mailing address

680 High St Ste a
Wadsworth, OH 44281-1690
Phone (330) 690-2337

Other identifiers 2

IdentifierTypeStateIssuer
E.0007875OtherOHLICENSE
0251028MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200615002730 OH Part B Supplier - Clinic/Group Practice 4486076718 Receives reassigned benefits from 5 practitioners
Practice locations: Wadsworth, OH

National Provider Directory

National Provider Directory

Locations

1219 High St
Wadsworth, OH 44281
Phone (234) 217-8001

680 High St
Ste A
Wadsworth, OH 44281
Phone (330) 631-2333

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1003355090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 HIGH ST STE A",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442811690",
            "telephone_number": "330-690-2337",
            "fax_number": "330-822-6955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 HIGH ST STE A",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442811690",
            "telephone_number": "306-902-3373",
            "fax_number": "330-822-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF CREEK WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-23",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "MAROON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "330-690-2337"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "34.009421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "E.0007875",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0251028",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadsworth, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.