Provider Demographics
NPI:1639771975
Name:ALPHA RECOVERY CENTER
Entity Type:Organization
Organization Name:ALPHA RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:NKENGAFAC
Authorized Official - Middle Name:
Authorized Official - Last Name:ETCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-584-4270
Mailing Address - Street 1:313 MARJORAM DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-7027
Mailing Address - Country:US
Mailing Address - Phone:614-584-4270
Mailing Address - Fax:614-343-1548
Practice Address - Street 1:1251 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1359
Practice Address - Country:US
Practice Address - Phone:614-897-9252
Practice Address - Fax:614-737-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty