Provider Demographics
NPI:1780243394
Name:SEACREST RECOVERY CENTER OHIO, LLC
Entity type:Organization
Organization Name:SEACREST RECOVERY CENTER OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-304-4928
Mailing Address - Street 1:6555 BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1739
Mailing Address - Country:US
Mailing Address - Phone:561-990-2620
Mailing Address - Fax:866-856-2122
Practice Address - Street 1:6555 BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1739
Practice Address - Country:US
Practice Address - Phone:561-990-2620
Practice Address - Fax:866-856-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty