Provider Demographics
NPI:1356612261
Name:ADDICTION OUTREACH CLINIC LTD
Entity type:Organization
Organization Name:ADDICTION OUTREACH CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ATANASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-259-4849
Mailing Address - Street 1:755 BOARDMAN - CANFIELD ROAD
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-259-4849
Mailing Address - Fax:330-629-2847
Practice Address - Street 1:819 MCKAY CT STE 102
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5771
Practice Address - Country:US
Practice Address - Phone:330-259-4849
Practice Address - Fax:330-629-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty