Basic Information
| Provider Information | |||||||||
| NPI: | 1669892428 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUEST RECOVERY AND PREVENTION SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1341 MARKET AVE N | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447142605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304538252 | ||||||||
| FaxNumber: | 3304536716 | ||||||||
| Practice Location | |||||||||
| Address1: | 1207 W STATE ST | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446014686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308213846 | ||||||||
| FaxNumber: | 3308215172 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | HOCHADEL | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3304538252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PCC-S, LCDCIII, SAP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 01-0619 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2901131 | 05 | OH | MEDICAID |