Healthcare Provider Details

I. General information

NPI: 1922496223
Provider Name (Legal Business Name): HOPE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 SHELBYVILLE RD STE 506
LOUISVILLE KY
40222-5164
US

IV. Provider business mailing address

9300 SHELBYVILLE RD STE 506
LOUISVILLE KY
40222-5164
US

V. Phone/Fax

Practice location:
  • Phone: 502-883-1454
  • Fax: 502-883-1456
Mailing address:
  • Phone: 502-883-1454
  • Fax: 502-883-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL CAUDILL
Title or Position: ADMINISTRATOR
Credential:
Phone: 502-883-1454