Healthcare Provider Details

I. General information

NPI: 1538366604
Provider Name (Legal Business Name): ABILITIES ADVANCEMENT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 COMBS RD SUITE ONE
HAZARD KY
41701-6851
US

IV. Provider business mailing address

257 COMBS RD SUITE ONE
HAZARD KY
41701-6851
US

V. Phone/Fax

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

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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE DARLENE JOHNSON
Title or Position: ATTORNEY AT LAW
Credential:
Phone: 606-436-2308