Healthcare Provider Details

I. General information

NPI: 1306215470
Provider Name (Legal Business Name): STEPWORKS RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MALABU DR STE 200
LEXINGTON KY
40502-3215
US

IV. Provider business mailing address

PO BOX 6209
ELIZABETHTOWN KY
42702-6209
US

V. Phone/Fax

Practice location:
  • Phone: 800-545-9031
  • Fax: 270-982-1284
Mailing address:
  • Phone: 800-545-9031
  • Fax: 270-982-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number800153
License Number StateKY

VIII. Authorized Official

Name: THOMAS G INGRAM
Title or Position: MEMBER
Credential: MD
Phone: 800-545-9031