Provider Demographics
NPI:1134859804
Name:POTTER HOUSE RECOVERY LLC
Entity type:Organization
Organization Name:POTTER HOUSE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:CDCA
Authorized Official - Phone:513-435-0379
Mailing Address - Street 1:2849 VEAZEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2503
Mailing Address - Country:US
Mailing Address - Phone:513-435-0379
Mailing Address - Fax:
Practice Address - Street 1:4900 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3916
Practice Address - Country:US
Practice Address - Phone:513-435-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty