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General NPI Number Information
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NPI Number | 1336753466
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Entity Type | Organization
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Legal Business Name | PUSH FOR RECOVERY, LLC
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Dates
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Enumeration Date | 09/05/2020
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Last Update Date | 09/05/2020
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Provider Practice Location Address
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Address Line | 3880 CLIME ROAD BUILDING 2/SUITE A
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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 | 614-507-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 5944 EPERNAY WAY
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City | GALLOWAY
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State | OH
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Zip | 43119-8588
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Country | US
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Telephone | 614-507-0713
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD FANNIN
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Credential |
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Telephone | 614-507-0713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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