| Basecamp Recovery Llc | |
|
815 W Broad St Ste 200 Columbus OH 43222-1478 | |
| (614) 799-1906 | |
| Not Available |
| Full Name | Basecamp Recovery Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 815 W Broad St Ste 200, Columbus, Ohio |
| Authorized Official Name and Position | Michelle Johnson (ADMINISTRATOR) |
| Authorized Official Contact | 6147170822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Basecamp Recovery Llc 815 W Broad St Ste 200 Columbus OH 43222-1478 Ph: (614) 717-0822 | Basecamp Recovery Llc 815 W Broad St Ste 200 Columbus OH 43222-1478 Ph: (614) 799-1906 |
| NPI Number | 1730702333 |
|---|---|
| Provider Enumeration Date | 05/19/2020 |
| Last Update Date | 11/14/2022 |
| Certification Date | 11/14/2022 |
| Medicare PECOS PAC ID | 7315362589 |
|---|---|
| Medicare Enrollment ID | O20200805000521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730702333 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa A Pirwitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770893570 PECOS PAC ID: 7214126499 Enrollment ID: I20110104001325 |
| Provider Name | Stephanie Anne Tronolone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447754643 PECOS PAC ID: 5698026011 Enrollment ID: I20180925001434 |
| Provider Name | Robert John Graessle |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1629274139 PECOS PAC ID: 0244385664 Enrollment ID: I20200805001854 |
| Provider Name | Bryan David Borland |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1457643637 PECOS PAC ID: 2769719053 Enrollment ID: I20200925000133 |
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