Basic Information
| Provider Information | |||||||||
| NPI: | 1427024124 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH RECOVERY SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 724 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457010724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405926724 | ||||||||
| FaxNumber: | 7405926728 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 COLUMBUS RD | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457011334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405926724 | ||||||||
| FaxNumber: | 7405926728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | GAY | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7405926724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD, LICDC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | 2314525 | OH | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 04375 | 01 | OH | ODADAS/ODMH UPI GJM BD | OTHER | 06755 | 01 | OH | ODADAS/ODMH UPI AHV BD | OTHER |