NPIMap

Organization Active NPI

Midwest Detox Center LLC

  • Substance Abuse Rehabilitation Facility
  • Maumee, OH
National Provider Identifier
1356903058
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
MIDWEST DETOX CENTER LLC
Practice address
1757 Indian Wood Cir
Maumee, OH 43537-4009
Phone
(833) 440-8642
NPI assigned
Jul 2, 2019
Organization subpart
Yes
Parent organization
MIDWEST DETOX CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Allison Heaberlin
Title
Credentialing Specialist
Phone
(410) 415-3385

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

1757 Indian Wood Cir
Maumee, OH 43537-4009

Mailing address

10461 Mill Run Cir Ste 810
Owings Mills, MD 21117-5549

Other practice location 1

1760 Manley Rd Bldg 1760
Maumee, OH 43537-9400
Phone (866) 688-6917

Other identifiers 1

IdentifierTypeStateIssuer
0281740MedicaidOH

Other names 1

  • Ohio Detox Center, LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Midwest Detox Center LLC3 organizations share this tax ID, including this one
Part of
Midwest Detox Center LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1760 Manley Rd
Bldg 1760
Maumee, OH 43537
Phone (833) 641-0572

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1356903058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 MILL RUN CIR STE 810",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211175549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1757 INDIAN WOOD CIR",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435374009",
            "telephone_number": "833-440-8642"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1760 Manley Rd Bldg 1760",
            "address_purpose": "LOCATION",
            "city": "Maumee",
            "state": "OH",
            "postal_code": "435379400",
            "country_code": "US",
            "telephone_number": "866-688-6917",
            "fax_number": "419-318-1603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDWEST DETOX CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST DETOX CENTER LLC",
        "enumeration_date": "2019-07-02",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "HEABERLIN",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "410-415-3385"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0281740",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ohio Detox Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ohio Detox Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.