| Recovery Innovations, Inc. | |
|
199 S Central Ave Columbus OH 43223-1301 | |
| (602) 650-1212 | |
| Not Available |
| Full Name | Recovery Innovations, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 199 S Central Ave, Columbus, Ohio |
| Authorized Official Name and Position | Maurice Lakes (CREDENTIALING SUPERVISOR) |
| Authorized Official Contact | 6026363085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recovery Innovations, Inc. 2701 N 16th St Ste 316 Phoenix AZ 85006-1266 Ph: (602) 571-3163 | Recovery Innovations, Inc. 199 S Central Ave Columbus OH 43223-1301 Ph: (602) 650-1212 |
| NPI Number | 1376254128 |
|---|---|
| Provider Enumeration Date | 12/12/2022 |
| Last Update Date | 01/05/2024 |
| Certification Date | 01/05/2024 |
| Medicare PECOS PAC ID | 1456500628 |
|---|---|
| Medicare Enrollment ID | O20241018001171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376254128 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
| Provider Name | Constance Renee Hartgrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407307473 PECOS PAC ID: 5890075071 Enrollment ID: I20161205001232 |
| Provider Name | Mamadou Saliou Diallo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922594746 PECOS PAC ID: 6507116332 Enrollment ID: I20180829000895 |
| Provider Name | Alexis Lefevre-casby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346724077 PECOS PAC ID: 9335492214 Enrollment ID: I20181023000392 |
| Provider Name | Tracy King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548878937 PECOS PAC ID: 5890194724 Enrollment ID: I20210526002594 |
| Provider Name | Na'sha I Onuoha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326710823 PECOS PAC ID: 0143619932 Enrollment ID: I20211117000809 |
| Provider Name | Jason Allen Counts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114478179 PECOS PAC ID: 9133652779 Enrollment ID: I20241104002798 |
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