Healthcare Provider Details

I. General information

NPI: 1568333847
Provider Name (Legal Business Name): ISAIAH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 MAIN ST
WILLISBURG KY
40078-8199
US

IV. Provider business mailing address

2044 MAIN ST
WILLISBURG KY
40078-8199
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LUCILLE KOEHL
Title or Position: VP
Credential:
Phone: 317-755-7433