Healthcare Provider Details

I. General information

NPI: 1124521315
Provider Name (Legal Business Name): ISAIAH HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BROADWAY ST STE 101
CHAPLIN KY
40012
US

IV. Provider business mailing address

PO BOX 188
WILLISBURG KY
40078-0188
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax: 859-375-9202
Mailing address:
  • Phone: 859-375-9200
  • Fax: 859-375-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SYDNEY A AYERS
Title or Position: BILLING MANAGER
Credential:
Phone: 859-375-9200