Healthcare Provider Details

I. General information

NPI: 1578085239
Provider Name (Legal Business Name): THE CREED OF RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 E MAIN ST
LANCASTER OH
43130-3809
US

IV. Provider business mailing address

PO BOX 243
SUGAR GROVE OH
43155-0243
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-6008
  • Fax:
Mailing address:
  • Phone: 614-404-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDRIA EVANS
Title or Position: CEO
Credential: CEO
Phone: 614-404-6008