Provider Demographics
NPI:1760157861
Name:BASECAMP RECOVERY CENTER
Entity Type:Organization
Organization Name:BASECAMP RECOVERY CENTER
Other - Org Name:BASECAMP RECOVERY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-717-0822
Mailing Address - Street 1:815 W BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1478
Mailing Address - Country:US
Mailing Address - Phone:614-717-0822
Mailing Address - Fax:614-300-7223
Practice Address - Street 1:815 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222
Practice Address - Country:US
Practice Address - Phone:614-300-7205
Practice Address - Fax:614-300-7223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BASECAMP RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
36-89099OtherNCPDP