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Organization
PORT45 RECOVERY LLC
Active
Organization
PORT45 RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON STALEY (CEO)
(419) 606-3141
Entity
Organization
Contact information
Practice address
1616 GRANT ST, PORTSMOUTH, OH 45662-3663
(740) 529-7356
Mailing address
921 EASTWIND DR STE 101, WESTERVILLE, OH 43081-5302
(614) 591-4710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
OH
Enumeration date
06/08/2016
Last updated
10/07/2019
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