Healthcare Provider Details

I. General information

NPI: 1750911590
Provider Name (Legal Business Name): CENTER FOR BETTER LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 HUSTONVILLE RD STE 7
DANVILLE KY
40422-2165
US

IV. Provider business mailing address

PO BOX 1764
DANVILLE KY
40423-1764
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-9598
  • Fax:
Mailing address:
  • Phone: 859-324-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CRISTI MARIE MARTIN
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 859-324-0032