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General NPI Number Information
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NPI Number | 1033808324
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Entity Type | Organization
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Legal Business Name | SHELTER IN PLACE
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 3880 CLIME RD
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City | COLUMBUS
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State | OH
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Zip | 43228-3532
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Country | US
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Telephone | 740-466-4103
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Fax |
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Provider Business Mailing Address
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Address Line | 90 E MAIN ST
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City | WEST JEFFERSON
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State | OH
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Zip | 43162-1206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSHUA WISEMAN
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Credential | LICDC
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Telephone | 740-466-4103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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