Provider Demographics
NPI:1528457991
Name:THE RADEBAUGH LLC
Entity type:Organization
Organization Name:THE RADEBAUGH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:RADEBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-374-0389
Mailing Address - Street 1:6015 BRAYMOORE DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9093
Mailing Address - Country:US
Mailing Address - Phone:614-374-0389
Mailing Address - Fax:740-879-4577
Practice Address - Street 1:18240 ROYALTON RD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5181
Practice Address - Country:US
Practice Address - Phone:440-580-4520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE RADEBAUGH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-22
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No273Y00000XHospital UnitsRehabilitation Unit
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit