Healthcare Provider Details

I. General information

NPI: 1770085722
Provider Name (Legal Business Name): MEBS HOLDINGS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4339 WINSTON AVE
COVINGTON KY
41015-1739
US

IV. Provider business mailing address

4339 WINSTON AVE
COVINGTON KY
41015-1739
US

V. Phone/Fax

Practice location:
  • Phone: 859-835-2573
  • Fax:
Mailing address:
  • Phone: 859-835-2573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NIKKI FANGMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-322-2435