Healthcare Provider Details

I. General information

NPI: 1295126233
Provider Name (Legal Business Name): HERBAL SECRETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CLIFF VIEW LANE
HAZARD KY
41701
US

IV. Provider business mailing address

PO BOX 2313
HAZARD KY
41702-2313
US

V. Phone/Fax

Practice location:
  • Phone: 606-233-0932
  • Fax:
Mailing address:
  • Phone: 606-233-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number1066050
License Number StateNM

VIII. Authorized Official

Name: MRS. RHODA CLAUDEAN OAKLEY
Title or Position: CEO
Credential: RN
Phone: 606-233-0832