Provider Demographics
NPI:1700521051
Name:THREE WATERS RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:THREE WATERS RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNET
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-967-1460
Mailing Address - Street 1:431 OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3375
Mailing Address - Country:US
Mailing Address - Phone:513-967-1460
Mailing Address - Fax:
Practice Address - Street 1:431 OHIO PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3375
Practice Address - Country:US
Practice Address - Phone:513-967-1460
Practice Address - Fax:513-456-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0244638Medicaid