Healthcare Provider Details

I. General information

NPI: 1609040617
Provider Name (Legal Business Name): NRA BARBOURVILLE HOME THERAPY CENTER KENTUCKY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR SUITE 3
BARBOURVILLE KY
40906-7917
US

IV. Provider business mailing address

315 HOSPITAL DR SUITE 3
BARBOURVILLE KY
40906-7917
US

V. Phone/Fax

Practice location:
  • Phone: 606-545-6600
  • Fax: 606-546-2964
Mailing address:
  • Phone: 606-545-6600
  • Fax: 606-546-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK R. FAWCETT
Title or Position: TREASURER
Credential:
Phone: 781-699-9000