Healthcare Provider Details

I. General information

NPI: 1992180343
Provider Name (Legal Business Name): FM HEALING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 CENTER DR SUITE 100
RICHMOND KY
40475-3838
US

IV. Provider business mailing address

1042 CENTER DR STE 100
RICHMOND KY
40475-3838
US

V. Phone/Fax

Practice location:
  • Phone: 859-575-1518
  • Fax: 502-808-6077
Mailing address:
  • Phone: 859-575-1518
  • Fax: 502-808-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number810478
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SARDAR N KHAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-779-2123