=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033070123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLCOMBE HOUSE OF HOPE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6885 LABURNUM DR
-----------------------------------------------------
City | CANAL WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43110-8599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-289-4193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 61
-----------------------------------------------------
City | REYNOLDSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43068-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-289-4193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JERMAINE ALI HARRIS
-----------------------------------------------------
Credential | CDCA
-----------------------------------------------------
Telephone | 386-289-4193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------