Healthcare Provider Details

I. General information

NPI: 1083231682
Provider Name (Legal Business Name): CHERAWEN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 TROY PIKE
VERSAILLES KY
40383-8924
US

IV. Provider business mailing address

4060 TROY PIKE
VERSAILLES KY
40383-8924
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-1225
  • Fax:
Mailing address:
  • Phone: 859-229-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHERYL MCCLAIN
Title or Position: MANAGER
Credential: MD
Phone: 859-229-1225