Healthcare Provider Details

I. General information

NPI: 1154006682
Provider Name (Legal Business Name): ISAIAH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10803 DEERING RD
LOUISVILLE KY
40272-4127
US

IV. Provider business mailing address

2084 MAIN ST
WILLISBURG KY
40078-8199
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH MICHAEL COX
Title or Position: PRESIDENT
Credential:
Phone: 859-375-9200