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Southern Ohio Premier Recovery, LLC

Organization Active NPI Substance Abuse Rehabilitation Facility · McDermott, OH

NPI 1235803115 · NPPES record last updated Mar 5, 2024

Key facts

NPI
1235803115
Entity type
Organization (NPI type 2)
Primary specialty
Substance Abuse Rehabilitation Facility 324500000X
Legal business name
SOUTHERN OHIO PREMIER RECOVERY, LLC
Practice address
6431 State Route 104
McDermott, OH 45652-8943
Phone
(740) 981-6987
NPI assigned
Aug 4, 2021
Organization subpart
No

Authorized official

Name
Mrs. Faith Ann Bivens
Title
Owner
Phone
(740) 981-6987

Corporate family (same tax ID) 1

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

Practitioners 1

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

National Provider Directory

Tax ID family
Southern Ohio Premier Recovery LLC (2 organizations share this tax ID)

Locations

6587 State Route 104
Mc Dermott, OH 45652

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Substance Abuse Rehabilitation Facility 324500000X Yes

Addresses

Primary practice location

6431 State Route 104
McDermott, OH 45652-8943

Mailing address

6587 State Route 104
MC Dermott, OH 45652-8943
Phone (740) 981-6987

Other providers in McDermott, OH

All providers in McDermott, OH · Substance Abuse Rehabilitation Facility in Ohio

Sources for this page

Verify at the official NPI Registry.