Healthcare Provider Details

I. General information

NPI: 1255778502
Provider Name (Legal Business Name): PREMIER RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4449 EASTON WAY STE 200
COLUMBUS OH
43219-6093
US

IV. Provider business mailing address

4449 EASTON WAY STE 200
COLUMBUS OH
43219-6093
US

V. Phone/Fax

Practice location:
  • Phone: 614-547-6237
  • Fax:
Mailing address:
  • Phone: 614-547-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number35084995
License Number StateOH

VIII. Authorized Official

Name: DR. TRUPTI V PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 614-547-6237