Provider Demographics
NPI:1851845275
Name:ADVANCED RECOVERY SERVICES
Entity Type:Organization
Organization Name:ADVANCED RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:AALIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNTLEROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-353-4232
Mailing Address - Street 1:326 S HIGH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4525
Mailing Address - Country:US
Mailing Address - Phone:614-918-3330
Mailing Address - Fax:
Practice Address - Street 1:326 S HIGH ST
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4525
Practice Address - Country:US
Practice Address - Phone:614-918-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH276400000X276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1972996213Medicaid