Healthcare Provider Details

I. General information

NPI: 1457750986
Provider Name (Legal Business Name): DBA JAMES R TONEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 PEACHTREE LN
BOWLING GREEN KY
42103-7007
US

IV. Provider business mailing address

185 PEACHTREE LN
BOWLING GREEN KY
42103-7007
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-9663
  • Fax:
Mailing address:
  • Phone: 270-901-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberKY-1491
License Number StateKY

VIII. Authorized Official

Name: MR. JAMES ROBERT TONEY
Title or Position: OWNER
Credential: LPCA
Phone: 270-901-9663