Healthcare Provider Details

I. General information

NPI: 1982494910
Provider Name (Legal Business Name): PROVIDE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 HIGHWAY 790
BRONSTON KY
42518-9464
US

IV. Provider business mailing address

3340 HIGHWAY 790
BRONSTON KY
42518-9464
US

V. Phone/Fax

Practice location:
  • Phone: 606-396-1702
  • Fax:
Mailing address:
  • Phone: 606-396-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: LILA COFFMAN
Title or Position: OWNER
Credential:
Phone: 606-396-1702