Healthcare Provider Details

I. General information

NPI: 1255099495
Provider Name (Legal Business Name): RIDGELINE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 GEORGESVILLE RD
COLUMBUS OH
43228-2420
US

IV. Provider business mailing address

491 GEORGESVILLE RD
COLUMBUS OH
43228-2420
US

V. Phone/Fax

Practice location:
  • Phone: 614-618-5000
  • Fax:
Mailing address:
  • Phone: 614-618-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDY DANEC
Title or Position: CEO
Credential:
Phone: 614-209-4046