Healthcare Provider Details

I. General information

NPI: 1164387593
Provider Name (Legal Business Name): ARMANDO TAYLOR RODRIGUEZ JR. PEER SUPPORT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 UNION ST STE B1
NEWARK OH
43055-3998
US

IV. Provider business mailing address

501 E VINE ST
MOUNT VERNON OH
43050-3601
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 330-275-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006304
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: