Organization · NPI-2

Ahi Medical Addictions Clinic, LLC

Family Medicine, Addiction Medicine · Mishawaka, IN

NPI number1457896896

StatusActive

Last updated in NPPESSep 1, 2020

Details

NPI: 1457896896
Entity type: Organization (NPI-2)
Legal business name: Ahi Medical Addictions Clinic, LLC
Organization subpart: No
Enumeration date: Dec 20, 2016
Certification date: Aug 31, 2020
Last updated: Sep 1, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207QA0401X	Family Medicine, Addiction Medicine	BX2361145	IN	Yes
101YA0400X	Counselor, Addiction (Substance Use Disorder)	–	–

Practice location

3006 Lincolnway E
Mishawaka, IN 46544-3501

Phone 574-252-7233 · Fax 844-361-2090

Mailing address

3006 Lincolnway E
Mishawaka, IN 46544-3501

Phone 574-252-7233 · Fax 844-361-2090

Authorized official

Emma C Wang
Owner
5742527233

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