Healthcare Provider Details

I. General information

NPI: 1356863203
Provider Name (Legal Business Name): ALEXANDER RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 WESTBOURNE AVE
COLUMBUS OH
43213
US

IV. Provider business mailing address

620 BEAR RUN LN
LEWIS CENTER OH
43035-8299
US

V. Phone/Fax

Practice location:
  • Phone: 844-735-2773
  • Fax:
Mailing address:
  • Phone: 614-706-5206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ALEXANDER
Title or Position: OWNER
Credential:
Phone: 844-735-2773