Healthcare Provider Details

I. General information

NPI: 1356665137
Provider Name (Legal Business Name): SOLACE CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAIN ST
VICCO KY
41773
US

IV. Provider business mailing address

PO BOX 286
JEFF KY
41751-0286
US

V. Phone/Fax

Practice location:
  • Phone: 606-476-9572
  • Fax:
Mailing address:
  • Phone: 606-476-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER COUCH
Title or Position: PROGRAM MANAGER
Credential:
Phone: 606-216-5080