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1790279131

NPI Code Detail

MEDICARE: OHIO ADDICTION MANAGEMENT LLC

MEDICARE: OHIO ADDICTION MANAGEMENT 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	101Y00000X	Counselor
2	101YP1600X	Pastoral Counselor
3	163WC0400X	Case Management Registered Nurse
4	163WC1500X	Community Health Registered Nurse
5	207QA0401X	Addiction Medicine (Family Medicine) Physician
6	261QP2300X	Primary Care Clinic/Center
7	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1790279131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO ADDICTION MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	5460 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1862
Country	:	US
Telephone Number	:	520-524-6084
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ORLANDO CARTER
Credential	:
Telephone Number	:	731-935-9267

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	04/26/2024

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Directions to “OHIO ADDICTION MANAGEMENT LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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