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General NPI Number Information
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NPI Number | 1740686013
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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 | 11/13/2014
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 2529 MAPLE AVE
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City | ZANESVILLE
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State | OH
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Zip | 43701-1833
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Country | US
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Telephone | 740-297-8859
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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 | 859-209-2305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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