Healthcare Provider Details

I. General information

NPI: 1740320084
Provider Name (Legal Business Name): OUR FRIENDS PLACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N HILL ST
LONDON KY
40741-1338
US

IV. Provider business mailing address

PO BOX 2558
LONDON KY
40743-2558
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-2631
  • Fax: 606-877-2635
Mailing address:
  • Phone: 606-877-2631
  • Fax: 606-877-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: MATT JONES
Title or Position: OWNER
Credential: PT
Phone: 606-877-2631