Healthcare Provider Details

I. General information

NPI: 1194179150
Provider Name (Legal Business Name): ACCESS OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 WAYNE AVE BLDG 64
DAYTON OH
45420-1833
US

IV. Provider business mailing address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

V. Phone/Fax

Practice location:
  • Phone: 614-256-7811
  • Fax:
Mailing address:
  • Phone: 614-655-3345
  • Fax: 614-317-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number13908
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number13909
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN JOHNSON
Title or Position: CEO
Credential:
Phone: 937-228-0579