Provider Demographics
NPI:1639231905
Name:SHELBY COUNTY RECOVERY INC.
Entity Type:Organization
Organization Name:SHELBY COUNTY RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:NULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-497-7355
Mailing Address - Street 1:202 N WALNUT AVE
Mailing Address - Street 2:PO BOX 158
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2626
Mailing Address - Country:US
Mailing Address - Phone:937-497-7355
Mailing Address - Fax:937-497-7593
Practice Address - Street 1:202 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2626
Practice Address - Country:US
Practice Address - Phone:937-497-7355
Practice Address - Fax:937-497-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10296Medicare UPIN