Healthcare Provider Details

I. General information

NPI: 1104450063
Provider Name (Legal Business Name): QUEST RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HARCOURT RD STE 2
MOUNT VERNON OH
43050-3944
US

IV. Provider business mailing address

112 HARCOURT RD STE 2
MOUNT VERNON OH
43050-3944
US

V. Phone/Fax

Practice location:
  • Phone: 740-263-7614
  • Fax:
Mailing address:
  • Phone: 740-263-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAVYN P. HOWELL
Title or Position: NURSE PRACTITIONER
Credential: APRN-BC
Phone: 682-224-9655