Healthcare Provider Details

I. General information

NPI: 1922497130
Provider Name (Legal Business Name): STEPWORKS RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 WOODLAND DR
ELIZABETHTOWN KY
42701-2709
US

IV. Provider business mailing address

PO BOX 6209
ELIZABETHTOWN KY
42702-6209
US

V. Phone/Fax

Practice location:
  • Phone: 800-545-9031
  • Fax: 270-982-1284
Mailing address:
  • Phone: 800-545-9031
  • Fax: 270-982-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberBHSO 800153
License Number StateKY

VIII. Authorized Official

Name: DR. THOMAS G INGRAM
Title or Position: OWNER
Credential: MD
Phone: 800-545-9031