Healthcare Provider Details

I. General information

NPI: 1780143826
Provider Name (Legal Business Name): BLESS THE LORD CHURCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 BRIDGETT DR
MT STERLING KY
40353-1601
US

IV. Provider business mailing address

236 BRIDGETT DR
MT STERLING KY
40353-1601
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-7111
  • Fax: 606-498-7100
Mailing address:
  • Phone: 859-498-7111
  • Fax: 859-498-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WAYNE ROSS
Title or Position: DIRECTOR
Credential: BSW, CADC
Phone: 859-509-3655