Provider Demographics
NPI:1316646722
Name:TALBOT CLINICAL SERVICES OF OHIO LLC
Entity type:Organization
Organization Name:TALBOT CLINICAL SERVICES OF OHIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-888-8704
Mailing Address - Street 1:173 S BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7249
Mailing Address - Country:US
Mailing Address - Phone:281-888-8704
Mailing Address - Fax:
Practice Address - Street 1:173 S BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-7249
Practice Address - Country:US
Practice Address - Phone:281-888-8704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder