Healthcare Provider Details

I. General information

NPI: 1386687192
Provider Name (Legal Business Name): ALC RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 WELLINGTON WAY SUITE 110
LEXINGTON KY
40513
US

IV. Provider business mailing address

1055 WELLINGTON WAY SUITE 275
LEXINGTON KY
40513-1259
US

V. Phone/Fax

Practice location:
  • Phone: 859-219-2822
  • Fax: 859-219-2825
Mailing address:
  • Phone: 859-219-2828
  • Fax: 859-219-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number21505
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30090
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateKY

VIII. Authorized Official

Name: ANN S GILES
Title or Position: OWNER
Credential:
Phone: 859-219-2828