Healthcare Provider Details

I. General information

NPI: 1619339736
Provider Name (Legal Business Name): CENTRAL KENTUCKY RECOVERY MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 US HIGHWAY 27 S STE A
CYNTHIANA KY
41031-7078
US

IV. Provider business mailing address

1094 US HIGHWAY 27 S STE A
CYNTHIANA KY
41031-7078
US

V. Phone/Fax

Practice location:
  • Phone: 859-569-3145
  • Fax: 859-569-3176
Mailing address:
  • Phone: 859-569-3145
  • Fax: 859-569-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACY S FRYMAN
Title or Position: OWNER
Credential:
Phone: 859-569-3145