1760157861 NPI number — BASECAMP RECOVERY CENTER

Table of content: (NPI 1760157861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760157861 NPI number — BASECAMP RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASECAMP RECOVERY CENTER
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:
Provider Other Organization Name Type Code:
6
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:
1760157861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 W BROAD ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43222-1478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-717-0822
Provider Business Mailing Address Fax Number:
614-300-7223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 WEST BROAD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-300-7205
Provider Business Practice Location Address Fax Number:
614-300-7223
Provider Enumeration Date:
08/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
614-717-0822

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 36-89099 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com