MEDICARE: CROWN BEHAVIORAL HEALTH (SA)

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility
4	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1659235463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN BEHAVIORAL HEALTH (SA)

Provider Business Mailing Address
First Line	:	4133 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2951
Country	:	US
Telephone Number	:	614-350-0013
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2951
Country	:	US
Telephone Number	:	614-350-0013
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CASEY BRIGHT
Credential	:	CEO
Telephone Number	:	614-350-0013

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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