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General NPI Number Information
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NPI Number | 1356724876
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Entity Type | Organization
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Legal Business Name | SELFREFIND OHIO LLC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 4312 OLD SCIOTO TRL
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City | PORTSMOUTH
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State | OH
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Zip | 45662-6642
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Country | US
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Telephone | 740-961-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 461 S 4TH ST
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City | DANVILLE
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State | KY
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Zip | 40422-2053
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Country | US
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Telephone | 859-209-2287
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES DURHAM
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Credential |
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Telephone | 859-209-2287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 13822
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License Number State | OH
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