Healthcare Provider Details

I. General information

NPI: 1063542538
Provider Name (Legal Business Name): AREA LIFE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 COMBS RD STE 2
HAZARD KY
41701
US

IV. Provider business mailing address

PO BOX 1990 257 COMBS RD STE 2
HAZARD KY
41701
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-2308
  • Fax: 606-436-0069
Mailing address:
  • Phone: 606-436-2308
  • Fax: 606-436-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANET CLARK SPARE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-435-0140