Healthcare Provider Details

I. General information

NPI: 1437695103
Provider Name (Legal Business Name): BALANCED RECOVERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 ALYSHEBA WAY SUITE 1001
LEXINGTON KY
40509-2280
US

IV. Provider business mailing address

151 COCONUT GROVE DR
NICHOLASVILLE KY
40356-2321
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-0416
  • Fax:
Mailing address:
  • Phone: 859-687-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: STEVANIE SMITH
Title or Position: PROGRAM DIRECTOR
Credential: M.ED., LPCC, LCADC
Phone: 859-687-0416