Provider Demographics
NPI:1639727936
Name:COMMUNITY ORIENTED RECOVERY
Entity Type:Organization
Organization Name:COMMUNITY ORIENTED RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EASTGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-815-1551
Mailing Address - Street 1:526 CANTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2527
Mailing Address - Country:US
Mailing Address - Phone:330-354-8684
Mailing Address - Fax:
Practice Address - Street 1:526 CANTON RD STE 201
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2527
Practice Address - Country:US
Practice Address - Phone:330-354-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01-7778OtherOHIO MENTAL HEALTH AND ADDICTION SERVICES (OMHAS)