Provider Demographics
NPI:1205345725
Name:HEALTHY LIVING RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:HEALTHY LIVING RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED SOCIAL WOER
Authorized Official - Prefix:
Authorized Official - First Name:DIONDRA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:513-616-7442
Mailing Address - Street 1:2525 WALDEN GLEN CIR APT A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1441
Mailing Address - Country:US
Mailing Address - Phone:513-616-7442
Mailing Address - Fax:
Practice Address - Street 1:2525 WALDEN GLEN CIR APT A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1441
Practice Address - Country:US
Practice Address - Phone:513-616-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
OHS1440334276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS1440334OtherLICENSED SOCIAL WORKER