Healthcare Provider Details

I. General information

NPI: 1205345725
Provider Name (Legal Business Name): HEALTHY LIVING RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WALDEN GLEN CIR APT A
CINCINNATI OH
45231-1441
US

IV. Provider business mailing address

2525 WALDEN GLEN CIR APT A
CINCINNATI OH
45231-1441
US

V. Phone/Fax

Practice location:
  • Phone: 513-616-7442
  • Fax:
Mailing address:
  • Phone: 513-616-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberS1440334
License Number StateOH

VIII. Authorized Official

Name: DIONDRA ROSE HOLLIDAY
Title or Position: OWNER/LICENSED SOCIAL WOER
Credential: LSW
Phone: 513-616-7442