Healthcare Provider Details

I. General information

NPI: 1912917543
Provider Name (Legal Business Name): KENTUCKY RIVER FOOTHILLS DEVELOPMENT COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 RIVER DR
IRVINE KY
40336-1142
US

IV. Provider business mailing address

209 RIVER DR
IRVINE KY
40336-1142
US

V. Phone/Fax

Practice location:
  • Phone: 606-723-6629
  • Fax: 606-723-9726
Mailing address:
  • Phone: 606-663-9011
  • Fax: 606-663-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number720280
License Number StateKY

VIII. Authorized Official

Name: VICKI M JOZEFOWICZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-624-2046