MEDICARE: ROSE OF SHARON HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		KY

General Provider Information

NPI Number	:	1144723453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE OF SHARON HOUSE

Provider Business Mailing Address
First Line	:	PO BOX 336
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440-0336
Country	:	US
Telephone Number	:	270-943-8202
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 W SHELBY ST
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440-8502
Country	:	US
Telephone Number	:	270-943-8202
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	DANYELL JOHNSON
Credential	:
Telephone Number	:	270-943-8202

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	03/13/2018

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Directions to “ROSE OF SHARON HOUSE ” Practice Location

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