Provider Demographics
NPI:1932685211
Name:HIGHLIFE RECOVERY, LLC
Entity Type:Organization
Organization Name:HIGHLIFE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-776-4646
Mailing Address - Street 1:5925 CLEVELAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-2209
Mailing Address - Country:US
Mailing Address - Phone:614-776-4646
Mailing Address - Fax:
Practice Address - Street 1:5925 CLEVELAND AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-2209
Practice Address - Country:US
Practice Address - Phone:614-776-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGHLIFE RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health