Provider Demographics
NPI:1760356935
Name:EMERALD CARE OH LLC
Entity type:Organization
Organization Name:EMERALD CARE OH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-917-6796
Mailing Address - Street 1:407 MALCOLM DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6107
Mailing Address - Country:US
Mailing Address - Phone:419-917-6796
Mailing Address - Fax:
Practice Address - Street 1:3100 W CENTRAL AVE STE 250
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2957
Practice Address - Country:US
Practice Address - Phone:419-917-6796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERALD CARE OH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)