Provider Demographics
NPI:1285143594
Name:BRYANS TREATMENT CENTER
Entity type:Organization
Organization Name:BRYANS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:NICKOLE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:CDCA, RA
Authorized Official - Phone:419-450-8273
Mailing Address - Street 1:6648 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9507
Mailing Address - Country:US
Mailing Address - Phone:1419-450-8273
Mailing Address - Fax:
Practice Address - Street 1:6648 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528
Practice Address - Country:US
Practice Address - Phone:1419-450-8273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OH201726803838251B00000X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No276400000XHospital UnitsRehabilitation, Substance Use Disorder UnitGroup - Multi-Specialty