Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jacob B Gilmore, LCDCIII

Individual provider Substance Abuse Rehabilitation Facility · NPI 1396397527

Jacob B Gilmore, LCDCIII is a Substance Abuse Rehabilitation Facility in Warren, Ohio. Practices as a sole proprietor and works from 2 locations. Licensed in Ohio.

Licensed in
OH
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

4930 Enterprise Dr NW
Warren, OH 44481-8706
Phone: (330) 787-0955
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2737 Youngstown Rd Se, Warren, OH 44484-5002 — (330) 369-8022

Specialties & licences

Addiction (Substance Use Disorder) Counselor (primary) Taxonomy 101YA0400X · Licence LCDCIII162380 (OH)
Substance Abuse Rehabilitation Facility Taxonomy 324500000X · Licence 170920 (OH)

Record details

NPI number1396397527
Entity typeIndividual (Type 1)
GenderMale
Credentials LCDCIII
Sole proprietorYes
NPI enumeratedJuly 9, 2019
Last updated in NPPESMarch 7, 2025
Certification dateMarch 7, 2025

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