|
| |
|
4963 Us Hwy 23 N Suite 121 Ivel KY 41642 | |
| (606) 653-1505 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4963 Us Hwy 23 N, Ivel, Kentucky |
| Authorized Official Name and Position | Eugene Sisco (ADMINISTRATOR) |
| Authorized Official Contact | 6066531503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 678 Betsy Layne KY 41605 Ph: (606) 653-1505 | 4963 Us Hwy 23 N Suite 121 Ivel KY 41642 Ph: (606) 653-1505 |
| NPI Number | 1144637232 |
|---|---|
| Provider Enumeration Date | 07/21/2014 |
| Last Update Date | 07/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144637232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |