MEDICARE: JOANNA HOUSE II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0800X	Recovery Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639675143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA HOUSE II

Provider Business Mailing Address
First Line	:	387 WEST BARTGES ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44307-1931
Country	:	US
Telephone Number	:	234-678-9805
Fax Number	:	330-849-5051

Provider Business Practice Location Address
First Line	:	342 E SOUTH ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-2165
Country	:	US
Telephone Number	:	234-678-9805
Fax Number	:	330-849-5051

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS LASALLE NOREEN HARRIS
Credential	:	CDCAIII, CPRS, S.W.
Telephone Number	:	234-678-9805

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/27/2022

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Directions to “JOANNA HOUSE II ” Practice Location

Language	Start Address	Practice Location

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