Healthcare Provider Details

I. General information

NPI: 1366210239
Provider Name (Legal Business Name): LIVE FOR RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MAIN ST RM 1
CIRCLEVILLE OH
43113-1619
US

IV. Provider business mailing address

90 EVERGREEN AVE
CIRCLEVILLE OH
43113-1014
US

V. Phone/Fax

Practice location:
  • Phone: 614-653-7736
  • Fax:
Mailing address:
  • Phone: 740-207-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TERESA CHEADLE
Title or Position: OWNER
Credential:
Phone: 740-207-1168