Healthcare Provider Details

I. General information

NPI: 1194161711
Provider Name (Legal Business Name): EMMAUS RESPITE AND RESOURCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MAIN ST
GREENUP KY
41144-1030
US

IV. Provider business mailing address

PO BOX 114
GREENUP KY
41144-0114
US

V. Phone/Fax

Practice location:
  • Phone: 606-547-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY DAVID SIZEMORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-547-1140