Healthcare Provider Details

I. General information

NPI: 1366911893
Provider Name (Legal Business Name): ISAIAH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
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 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 Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH A COX
Title or Position: PRESIDENT
Credential:
Phone: 859-375-9200