Healthcare Provider Details

I. General information

NPI: 1316061658
Provider Name (Legal Business Name): KENTUCKY RIVER COMMUNITY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

IV. Provider business mailing address

115 ROCKWOOD LN
HAZARD KY
41701-9415
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-5761
  • Fax: 606-436-5797
Mailing address:
  • Phone: 606-436-5761
  • Fax: 606-436-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
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
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MARCIA ADAMS
Title or Position: CFO
Credential:
Phone: 606-666-4351