NPIMap

Organization Active NPI

Licking County Alcoholism Prevention Program

  • Addiction (Substance Use Disorder) Counselor
  • Newark, OH
National Provider Identifier
1124089438
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
01322 Issued in OH
Legal business name
LICKING COUNTY ALCOHOLISM PREVENTION PROGRAM
Practice address
62 E Stevens St
Newark, OH 43055-5969
Phone
(740) 366-7303
Fax
(740) 366-7305
NPI assigned
Mar 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John JordanNPI 1518558857
Title
Executive Director
Phone
(740) 403-9494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X 01322 OH Primary

Addresses

Primary practice location

62 E Stevens St
Newark, OH 43055-5969

Mailing address

62 E Stevens St
Newark, OH 43055-5969
Phone (740) 366-7303

Other practice location 1

621 Broad St SW
Pataskala, OH 43062-8118
Phone (740) 366-7303

Other identifiers 2

IdentifierTypeStateIssuer
01322OtherOHODADAS
45-579-01MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160907001091 OH Part B Supplier - Clinic/Group Practice 9537455266 Receives reassigned benefits from 3 practitioners
Practice locations: Newark, OH; Pataskala, OH

National Provider Directory

National Provider Directory
Tax ID family
Licking County Alcoholism Prevention Program2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

621 Broad St SW
Pataskala, OH 43062
Phone (740) 366-7303

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1124089438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 E STEVENS ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430555969",
            "telephone_number": "740-366-7303",
            "fax_number": "740-366-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "62 E STEVENS ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430555969",
            "telephone_number": "740-366-7303",
            "fax_number": "740-366-7305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "621 Broad St SW",
            "address_purpose": "LOCATION",
            "city": "Pataskala",
            "state": "OH",
            "postal_code": "430628118",
            "country_code": "US",
            "telephone_number": "740-366-7303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LICKING COUNTY ALCOHOLISM PREVENTION PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-403-9494"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "01322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODADAS",
            "identifier": "01322",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45-579-01",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.