| Glen Dale Center | |
|
1030 Commerce Dr Elizabethtown KY 42701-1281 | |
| (270) 506-1064 | |
| Not Available |
| Full Name | Glen Dale Center |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1030 Commerce Dr, Elizabethtown, Kentucky |
| Authorized Official Name and Position | Sharon C' De Baca (EXECUTIVE ASSISTANT TO PRESIDENT) |
| Authorized Official Contact | 5025381010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen Dale Center Po Box 1429 Mt Washington KY 40047-1429 Ph: (502) 538-1000 | Glen Dale Center 1030 Commerce Dr Elizabethtown KY 42701-1281 Ph: (270) 506-1064 |
| NPI Number | 1962083014 |
|---|---|
| Provider Enumeration Date | 04/20/2021 |
| Last Update Date | 10/25/2022 |
| Certification Date | 10/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962083014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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