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Organization

FAR REACH FOUNDATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRIAN DEAN (CLO)
(614) 949-0287
Entity
Organization

Contact information

Practice address
620 BEAR RUN LN STE B, LEWIS CENTER, OH 43035-8299
(866) 624-7001
Mailing address
620 BEAR RUN LN STE B, LEWIS CENTER, OH 43035-8299

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
207RA0401X
Addiction Medicine (Internal Medicine) Physician
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
208D00000X
General Practice Physician
Primary

Other

Enumeration date
09/19/2017
Last updated
09/19/2017
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