Healthcare Provider Details

I. General information

NPI: 1669163929
Provider Name (Legal Business Name): RICH STOWERS CERTIFIED PEER RECOV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 WINONA AVE
DAYTON OH
45405-1627
US

IV. Provider business mailing address

4214 WINONA AVE
DAYTON OH
45405-1627
US

V. Phone/Fax

Practice location:
  • Phone: 937-613-0941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberAPS.OO4149
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number171M00000X
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004149
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: