Healthcare Provider Details

I. General information

NPI: 1134859804
Provider Name (Legal Business Name): POTTER HOUSE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 GLENWAY AVE
CINCINNATI OH
45238-3916
US

IV. Provider business mailing address

5912 BRIDGEVIEW CT
CINCINNATI OH
45248-4009
US

V. Phone/Fax

Practice location:
  • Phone: 513-435-0379
  • Fax:
Mailing address:
  • Phone: 513-300-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CHARLES ALLEN DAY
Title or Position: CEO
Credential: CDCA
Phone: 513-435-0379