Provider Demographics
NPI:1114472289
Name:HIGHLIFE RECOVERY, LLC
Entity Type:Organization
Organization Name:HIGHLIFE RECOVERY, LLC
Other - Org Name:HIGHLIFE RECOVERY
Other - Org Type:Other Name
Authorized Official - Title/Position:MM/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-776-4646
Mailing Address - Street 1:5925 CLEVELAND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2208
Mailing Address - Country:US
Mailing Address - Phone:614-776-4646
Mailing Address - Fax:614-398-0039
Practice Address - Street 1:5925 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2208
Practice Address - Country:US
Practice Address - Phone:614-776-4646
Practice Address - Fax:800-275-2415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLIFE HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066575251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health