Healthcare Provider Details

I. General information

NPI: 1740329135
Provider Name (Legal Business Name): KENTUCKY RIVER CHILDREN'S ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 CEDAR ST
HAZARD KY
41701-1511
US

IV. Provider business mailing address

465 CEDAR ST
HAZARD KY
41701-1511
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-9173
  • Fax: 606-487-1644
Mailing address:
  • Phone: 606-487-9173
  • Fax: 606-487-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA W QUILLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 606-487-9173