Healthcare Provider Details

I. General information

NPI: 1336753466
Provider Name (Legal Business Name): PUSH FOR RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2020
Last Update Date: 09/05/2020
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 CLIME ROAD BUILDING 2/SUITE A
COLUMBUS OH
43228-3532
US

IV. Provider business mailing address

5944 EPERNAY WAY
GALLOWAY OH
43119-8588
US

V. Phone/Fax

Practice location:
  • Phone: 614-507-0713
  • Fax:
Mailing address:
  • Phone: 614-507-0713
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD FANNIN
Title or Position: OWNER
Credential:
Phone: 614-507-0713