Healthcare Provider Details

I. General information

NPI: 1093042038
Provider Name (Legal Business Name): JMHC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 CONCRETE RD
CARLISLE KY
40311-9700
US

IV. Provider business mailing address

2330 CONCRETE RD
CARLISLE KY
40311-9700
US

V. Phone/Fax

Practice location:
  • Phone: 859-289-2212
  • Fax: 859-289-7510
Mailing address:
  • Phone: 859-289-2212
  • Fax: 859-289-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number600054
License Number StateKY

VIII. Authorized Official

Name: MS. SANDY BAILEY
Title or Position: COO
Credential:
Phone: 859-289-7181