Healthcare Provider Details

I. General information

NPI: 1932744745
Provider Name (Legal Business Name): STEPWORKS RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 RING RD STE 500
ELIZABETHTOWN KY
42701-7991
US

IV. Provider business mailing address

PO BOX 6209
ELIZABETHTOWN KY
42702-6209
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-5900
  • Fax: 270-982-1284
Mailing address:
  • Phone: 888-259-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABBY DIAZ HARPOOL
Title or Position: CREDENTIALING
Credential:
Phone: 270-317-0169