PORT45 RECOVERY LLC NPI 1780033993

NPI Information

NPI: 1780033993
Provider Name: PORT45 RECOVERY LLC
Classification: Counselor - 101YA0400X
Entity Type: Organization

Specialization: Addiction (Substance Use Disorder)

Address:
1616 GRANT ST
PORTSMOUTH, OH
ZIP 45662
Phone: (740) 529-7356
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PORT45 RECOVERY LLC is an addiction (substance use disorder) counselor in Portsmouth, OH. PORT45 RECOVERY LLC NPI is 1780033993. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1616 GRANT ST
PORTSMOUTH, OH
ZIP 45662-663
Phone: (740) 529-7356

The provider's authorized official is Sharon Staley .
The authorized official title is Ceo and has the following contact phone number (419) 606-3141.

The enumeration date for this NPI number is 6/8/2016 and was last updated on 10/7/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	101YA0400X	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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