| Organization Name: | FOSTORIA ALCOHOL/DRUG CENTER |
| NPI Number: | 1669885265 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ZIMMERMAN (EXECUTIVE DIRECTOR) |
| Mailing Address: | 222 S Main St Ste B Fostoria |
| State: | OH US |
| Postal Code: | 448302321 |
| Phone Number: | 4194359465 |
| Fax Number: | 4194350493 |
| NPI Enumeration Date: | 06/11/2014 |
| NPI Last Update Date: | 06/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1479 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |