Healthcare Provider Details

I. General information

NPI: 1720798523
Provider Name (Legal Business Name): ISAIAH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SLONE DR STE 1&2
GEORGETOWN KY
40324-1162
US

IV. Provider business mailing address

751 SLONE DR STE 1&2
GEORGETOWN KY
40324-1162
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax:

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 MICHAEL COX
Title or Position: PRESIDENT
Credential:
Phone: 859-375-9200