Provider Demographics
NPI:1356020515
Name:HOMELAND ADDICTION TREATMENT CENTER LLC
Entity type:Organization
Organization Name:HOMELAND ADDICTION TREATMENT CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:EYONG
Authorized Official - Last Name:ENOW
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:614-715-8316
Mailing Address - Street 1:3505 E LIVINGSTON AVE STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2252
Mailing Address - Country:US
Mailing Address - Phone:614-715-8216
Mailing Address - Fax:614-715-8239
Practice Address - Street 1:3505 E LIVINGSTON AVE STE G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2252
Practice Address - Country:US
Practice Address - Phone:614-632-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty