Healthcare Provider Details

I. General information

NPI: 1306583497
Provider Name (Legal Business Name): GLIMMER OF HOPE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-2604
US

IV. Provider business mailing address

700 W LINCOLN TRAIL BLVD
RADCLIFF KY
40160-2604
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-3192
  • Fax: 270-351-5499
Mailing address:
  • Phone: 270-351-3192
  • Fax: 270-351-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE TARPLEY
Title or Position: BILLING ADMIN
Credential:
Phone: 270-986-7044