Healthcare Provider Details

I. General information

NPI: 1821517160
Provider Name (Legal Business Name): STEPWORKS RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 RING RD STE 230
ELIZABETHTOWN KY
42701-4411
US

IV. Provider business mailing address

1690 RING RD STE 230
ELIZABETHTOWN KY
42701-4411
US

V. Phone/Fax

Practice location:
  • Phone: 800-545-9031
  • Fax: 270-982-1284
Mailing address:
  • Phone:
  • 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: DR. THOMAS INGRAM
Title or Position: OWNER
Credential: MD
Phone: 800-545-9031