Healthcare Provider Details

I. General information

NPI: 1700413424
Provider Name (Legal Business Name): WARRIORS 4 CHRIST RECOVERY MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 E MOUND ST
JACKSON OH
45640-1226
US

IV. Provider business mailing address

PO BOX 56
JACKSON OH
45640-0056
US

V. Phone/Fax

Practice location:
  • Phone: 740-577-3834
  • Fax:
Mailing address:
  • Phone: 740-466-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN OYER
Title or Position: EXECUTIVE DIRECTOR
Credential: CDCA
Phone: 740-577-8348