MEDICARE: STONEBRIDGE 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1770371098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE RECOVERY,LLC

Provider Business Mailing Address
First Line	:	800 CROSS POINTE RD STE P
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-6690
Country	:	US
Telephone Number	:	614-804-5194
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 CROSS POINTE RD STE P
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-6690
Country	:	US
Telephone Number	:	614-804-5194
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID MAINA
Credential	:
Telephone Number	:	614-804-5194

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/29/2025

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