Healthcare Provider Details

I. General information

NPI: 1932505427
Provider Name (Legal Business Name): CORNER OF HOPE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 STANDARD AVE
LOUISVILLE KY
40210-1639
US

IV. Provider business mailing address

1811 STANDARD AVE
LOUISVILLE KY
40210-1639
US

V. Phone/Fax

Practice location:
  • Phone: 502-413-0102
  • Fax:
Mailing address:
  • Phone: 502-413-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number810451
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number810401
License Number StateKY

VIII. Authorized Official

Name: MR. KEDRICK TEMBO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 502-413-0102