THREE WATERS RECOVERY CENTER, LLC (NPI# 1710426036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710426036 |
| Entity Type | Organization |
| Organization Name | THREE WATERS RECOVERY CENTER, LLC |
| Practice Address |
6722 State Route 132 Ste A Goshen OH 45122-9346 |
| Practice Telephone | 5135757879 |
| Mailing Telephone | 5135757879 |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2017-11-07 |
| Authorized Official Name | MRS. MELINDA M ADAMS (OWNER/ DIRECTOR) |
| Authorized Official Telephone | 5139671460 |
| Authorized Official Credential | MA. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Street Address |
6722 STATE ROUTE 132 STE A |
| City | GOSHEN |
| State | OH |
| Zip Code | 45122-9346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720453392 | Joan Susan Wahl | Nurse Practitioner | 6722 State Route 132 Ste A, Goshen, OH 45122-9346 | 2015-12-08 |
| 1790254480 | Candice Lynne Paolino | Counselor | 6722 State Route 132 Ste A, Goshen, OH 45122-9346 | 2018-11-25 |
| 1659883940 | Clarisse Nyam | Nurse Practitioner | 6722 State Route 132 Ste A, Goshen, OH 45122-9346 | 2017-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790807949 | Merwin Russell Jones IIi | Dentist | 6782 Goshen Road, Goshen, OH 45122 | 2007-04-06 |
| 1326566670 | Kimberly Ann Davis | Counselor | 313 Chillicothe Ave, Hillsboro, OH 45122 | 2017-09-07 |
| 1558395277 | Kroger Limited Partnership I | Pharmacy | 6725 Dick Flynn Blvd, Goshen, OH 45122-8025 | 2006-07-10 |
| 1851921704 | Julie Dorenbusch | Pharmacist | 6725 Dick Flynn Blvd, Goshen, OH 45122-8025 | 2020-01-20 |
| 1295375533 | Melissa M Greene | Pharmacist | 6725 Dick Flynn Blvd, Goshen, OH 45122-8025 | 2020-01-15 |
| 1447659701 | Donald Clark | Pharmacist | 6725 Dick Flynn Blvd, Goshen, OH 45122-8025 | 2014-08-22 |
| 1639718281 | Arnetta Williams | Home Health Aide | 505 Country Lake Cir, Goshen, OH 45122-8428 | 2019-12-31 |
| 1720627375 | Liz Loving Hands Home Care | Home Health | 505 Country Lake Cir, Goshen, OH 45122-8428 | 2019-12-31 |
| 1649240136 | Mary A Lim Lee | Internal Medicine | 6746 Dick Flynn Blvd, Goshen, OH 45122-8609 | 2006-01-25 |
| 1043373517 | Mary A Lee Md Inc | Internal Medicine | 6746 Dick Flynn Blvd, Goshen, OH 45122-8609 | 2006-12-18 |
| Find all providers in zip 45122 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.