1699732628 NPI number — SOJOURNER RECOVERY SERVICES, INC.

Table of content: (NPI 1699732628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699732628 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:
1699732628
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:
513-645-4578
Provider Business Mailing Address Fax Number:
513-883-1546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 DAYTON ST
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:
45011-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-868-7654
Provider Business Practice Location Address Fax Number:
513-737-0026
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GEHRING
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
513-868-7654

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 11228,02516,1016,111 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2516 . This is a "UPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2921146 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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