Healthcare Provider Details

I. General information

NPI: 1124471370
Provider Name (Legal Business Name): FAMILY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LANE
HAZARD KY
41701
US

IV. Provider business mailing address

100 VETERANS DR
HAZARD KY
41701-9483
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-3399
  • Fax: 606-487-9280
Mailing address:
  • Phone: 606-439-3399
  • Fax: 606-487-9280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. FAIRLENA KAYE BAKUN
Title or Position: OWNER
Credential: D.C.
Phone: 606-439-3399