1124530704 NPI number — SOJOURNER RECOVERY SERVICES, INC.

Table of content: (NPI 1124530704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124530704 NPI number — SOJOURNER RECOVERY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOJOURNER RECOVERY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOJOURNER RECOVERY SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124530704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 SYMMES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-896-8300
Provider Business Mailing Address Fax Number:
513-883-1546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45011-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-896-3497
Provider Business Practice Location Address Fax Number:
513-785-4495
Provider Enumeration Date:
11/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
GEHRING
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
513-896-3441

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04202274 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com