| Sean Phillips Recovery Center Llc | |
|
695 S Mount Vernon Ave Loudonville OH 44842-1414 | |
| (614) 832-7647 | |
| Not Available |
| Full Name | Sean Phillips Recovery Center Llc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 695 S Mount Vernon Ave, Loudonville, Ohio |
| Authorized Official Name and Position | Chauncey D Wallace (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6148327647 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sean Phillips Recovery Center Llc 604 Office Pkwy Westerville OH 43082-7938 Ph: (614) 430-9590 | Sean Phillips Recovery Center Llc 695 S Mount Vernon Ave Loudonville OH 44842-1414 Ph: (614) 832-7647 |
| NPI Number | 1407553894 |
|---|---|
| Provider Enumeration Date | 02/15/2023 |
| Last Update Date | 02/15/2023 |
| Certification Date | 02/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407553894 | NPI | - | NPPES |
| 1215407945 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |