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NPI Code Detail

MEDICARE: POTTER HOUSE RECOVERY LLC

MEDICARE: POTTER HOUSE RECOVERY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1343900000XNon-emergency Medical Transport (VAN)
2101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134859804
Entity Type Code : Organization
Provider Name (Legal Business Name) : POTTER HOUSE RECOVERY LLC
Provider Business Mailing Address
First Line : 5912 BRIDGEVIEW CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45248-4009
Country : US
Telephone Number : 513-300-6483
Fax Number :
Provider Business Practice Location Address
First Line : 4900 GLENWAY AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3916
Country : US
Telephone Number : 513-435-0379
Fax Number :
Authorized Official
Title or Position : CEO
Name : CHARLES ALLEN DAY
Credential : CDCA
Telephone Number : 513-435-0379
Provider Enumeration Date : 06/14/2022
Last Update Date : 07/07/2025

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Directions to “POTTER HOUSE RECOVERY LLC ” Practice Location

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