Sean Phillips Recovery Center LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

SEAN PHILLIPS RECOVERY CENTER LLC

Doing business as

Sean Phillips Recovery Center

Practice address

695 S Mount Vernon Ave
Loudonville, OH 44842-1414

Phone

(614) 832-7647

NPI assigned

Feb 15, 2023

Last updated

Feb 15, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Chauncey D WallaceNPI 1215407945

Title

Chief Executive Officer

Phone

(614) 832-7647

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sean Phillips Recovery Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chauncey Wallace, CDCA

  • Addiction (Substance Use Disorder) Counselor
  • Marion, OH
  • NPI 1215407945
  NPD Authorized official

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

{
    "created_epoch": "1676419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676419200000",
    "number": "1407553894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 OFFICE PKWY",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "430827938",
            "telephone_number": "614-430-9590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 S MOUNT VERNON AVE",
            "city": "LOUDONVILLE",
            "state": "OH",
            "postal_code": "448421414",
            "telephone_number": "614-832-7647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAN PHILLIPS RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-15",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CHAUNCEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "614-832-7647"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215407945",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sean Phillips Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marcus David Rohde
• Tiffany Marie Ryan, LPN
• Scott Dental Group L L C
• Darrel L Scott, D.D.S.
• Tyler Lynn Scott, DDS
• Nicole Shannon
• Trina Smith, LPN
• Rileigh Lynn Stake, COTA/L
• Rodney Lynn Stinemetz, DC
• Amy Tafur-Pardo

• Addiction (Substance Use Disorder) Counselor in Loudonville, OH
• Providers in Loudonville, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.