Healthcare Provider Details

I. General information

NPI: 1467826453
Provider Name (Legal Business Name): FIRST STEP RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 BRICE RD
REYNOLDSBURG OH
43068-2799
US

IV. Provider business mailing address

1649 BRICE RD STE C
REYNOLDSBURG OH
43068-2796
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-5878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number34006086
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number34006086
License Number StateOH

VIII. Authorized Official

Name: PAUL GOR
Title or Position: OWNER
Credential:
Phone: 614-300-5878