Healthcare Provider Details

I. General information

NPI: 1396148375
Provider Name (Legal Business Name): ADDICTION ANGELS OF AMERICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 SINCLAIR RD SUITE 111
COLUMBUS OH
43229-5432
US

IV. Provider business mailing address

4889 SINCLAIR RD SUITE 111
COLUMBUS OH
43229-5432
US

V. Phone/Fax

Practice location:
  • Phone: 614-886-4287
  • Fax:
Mailing address:
  • Phone: 614-396-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER GARCIA
Title or Position: PRESIDENT
Credential:
Phone: 614-396-7850