Healthcare Provider Details

I. General information

NPI: 1346923992
Provider Name (Legal Business Name): PEER SOLUTIONS RECOVERY OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 PIKE ST
MARIETTA OH
45750-3522
US

IV. Provider business mailing address

1017 PIKE ST
MARIETTA OH
45750-3522
US

V. Phone/Fax

Practice location:
  • Phone: 740-856-1084
  • Fax:
Mailing address:
  • Phone: 740-856-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
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: MERIAH WALTERS
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 740-856-1084