Healthcare Provider Details

I. General information

NPI: 1356020515
Provider Name (Legal Business Name): HOMELAND ADDICTION TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 E LIVINGSTON AVE STE G
COLUMBUS OH
43227-2252
US

IV. Provider business mailing address

3505 E LIVINGSTON AVE STE G
COLUMBUS OH
43227-2252
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-1018
  • Fax:
Mailing address:
  • Phone: 614-715-8216
  • Fax: 614-715-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KINGSLEY EYONG ENOW
Title or Position: SUPERVISOR
Credential: NP
Phone: 614-715-8316