Healthcare Provider Details

I. General information

NPI: 1982133922
Provider Name (Legal Business Name): KENTUCKY'S CHOICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MAIN ST STE B
VERSAILLES KY
40383-1582
US

IV. Provider business mailing address

225 B S MAIN STREET
VERSAILLES KY
40383
US

V. Phone/Fax

Practice location:
  • Phone: 859-489-6557
  • Fax:
Mailing address:
  • Phone: 859-489-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800249
License Number StateKY

VIII. Authorized Official

Name: MARY HUGHES
Title or Position: CREDENTIALING SPECIALIST
Credential: BA
Phone: 859-494-8590