Provider Demographics
NPI:1275589178
Name:PIKE COUNTY RECOVERY COUNCIL INC
Entity Type:Organization
Organization Name:PIKE COUNTY RECOVERY COUNCIL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CDCA
Authorized Official - Phone:740-947-6727
Mailing Address - Street 1:P.O. BOX 226
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-0226
Mailing Address - Country:US
Mailing Address - Phone:740-947-6727
Mailing Address - Fax:740-947-6917
Practice Address - Street 1:217 E. EMMITT AVE.
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1337
Practice Address - Country:US
Practice Address - Phone:740-947-6727
Practice Address - Fax:740-947-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH527733251K00000X
OH251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH527733OtherSTATE LICENSE NUMBER
OH527733OtherSTATE LICENSE NUMBER
OH01446Medicare UPIN