Provider Demographics
NPI:1730647348
Name:CHRIST RECOVERY OF SAINTS & SINNERS,
Entity Type:Organization
Organization Name:CHRIST RECOVERY OF SAINTS & SINNERS,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LICDC
Authorized Official - Phone:513-429-4443
Mailing Address - Street 1:260 NORTHLAND BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3651
Mailing Address - Country:US
Mailing Address - Phone:513-429-4443
Mailing Address - Fax:513-429-5559
Practice Address - Street 1:260 NORTHLAND BLVD STE 209
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3651
Practice Address - Country:US
Practice Address - Phone:513-429-4443
Practice Address - Fax:513-429-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213163Medicaid