Healthcare Provider Details

I. General information

NPI: 1023583788
Provider Name (Legal Business Name): LIFE CENTERS FOR HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 COLUMBIA PKWY STE 1
CINCINNATI OH
45226-2137
US

IV. Provider business mailing address

3571 COLUMBIA PKWY STE 1
CINCINNATI OH
45226-2137
US

V. Phone/Fax

Practice location:
  • Phone: 513-254-1300
  • Fax:
Mailing address:
  • Phone: 513-254-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK ORLO PORTMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-254-1300