Provider Demographics
NPI:1730622895
Name:ON DEMAND OPIATE RECOVERY, LLC
Entity type:Organization
Organization Name:ON DEMAND OPIATE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-3660
Mailing Address - Street 1:102 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3963
Mailing Address - Country:US
Mailing Address - Phone:330-270-3660
Mailing Address - Fax:
Practice Address - Street 1:102 WESTCHESTER DR
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3963
Practice Address - Country:US
Practice Address - Phone:330-270-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ON DEMAND SUBOXONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty