Provider Demographics
NPI:1063462109
Name:PICKAWAY AREA RECOVERY SERVICES
Entity Type:Organization
Organization Name:PICKAWAY AREA RECOVERY SERVICES
Other - Org Name:FAYETTE RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-477-1745
Mailing Address - Street 1:110 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1208
Mailing Address - Country:US
Mailing Address - Phone:740-477-1745
Mailing Address - Fax:740-477-2779
Practice Address - Street 1:110 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1208
Practice Address - Country:US
Practice Address - Phone:740-477-1745
Practice Address - Fax:740-477-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1433Medicare UPIN