MEDICARE: GAP RECOVERY CENTER 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1861353591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAP RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	2741 CLEVELAND AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4406
Country	:	US
Telephone Number	:	614-327-7348
Fax Number	:	937-351-6633

Provider Business Practice Location Address
First Line	:	2741 CLEVELAND AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4406
Country	:	US
Telephone Number	:	614-327-7348
Fax Number	:	937-351-6633

Authorized Official
Title or Position	:	MANAGING EMPLOYEE
Name	:	CHANDRASHEKAR CHALUMALLA
Credential	:
Telephone Number	:	614-327-7348

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/22/2025

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Directions to “GAP RECOVERY CENTER LLC ” Practice Location

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