Southern Ohio Premier Recovery, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SOUTHERN OHIO PREMIER RECOVERY, LLC

Practice address

6431 State Route 104
McDermott, OH 45652

Phone

(740) 981-6987

NPI assigned

Sep 30, 2021

Last updated

Mar 8, 2024By 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

Mrs. Faith Ann Bivens

Title

Owner

Phone

(740) 981-6987

Specialties & licenses 1

Addresses

Tax ID family

Southern Ohio Premier Recovery LLC2 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.

• Southern Ohio Premier Recovery, LLC

  • Substance Abuse Rehabilitation Facility
  • McDermott, OH
  • NPI 1235803115
  NPD tax ID

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.

• Goble Oneal Hammonds

  • Case Manager/Care Coordinator
  • McDermott, OH
  • NPI 1992480883
  NPD

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1427720275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6587 STATE ROUTE 104",
            "city": "MC DERMOTT",
            "state": "OH",
            "postal_code": "456528943",
            "telephone_number": "740-981-6987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 STATE ROUTE 104",
            "city": "MCDERMOTT",
            "state": "OH",
            "postal_code": "45652",
            "telephone_number": "740-981-6987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO PREMIER RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "BIVENS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "740-981-6987",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Thomas Sharkey, CDCA PRS CMS
• Cody Shy, CDCA, PRS
• Dustin Slater, CMS, QMHS
• Timothy Slone
• Southern Ohio Premier Recovery, LLC
• Stateline Rentals LLC (Good-Deal Handyman Services)
• Thi of Ohio at Woodland LLC (Woodland Care Center)
• Kindra Sue Tumbleson
• Union Township Volunteer Fire Department
• Bryan Vest, CMS, QMHS

• Substance Use Disorder Rehabilitation Clinic/Center in McDermott, OH
• Providers in McDermott, OH by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.