1346696838 NPI number — ADDICTION RECOVERY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346696838 NPI number — ADDICTION RECOVERY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDICTION RECOVERY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346696838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3651 US HWY 2565
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
LOUISA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-826-0363
Provider Business Mailing Address Fax Number:
606-826-0144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3651 US HIGHWAY 2565
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-826-0363
Provider Business Practice Location Address Fax Number:
606-826-0144
Provider Enumeration Date:
05/13/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF STAFF TO CEO
Authorized Official Telephone Number:
606-826-0142

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)