Healthcare Provider Details

I. General information

NPI: 1396086559
Provider Name (Legal Business Name): ISAIAH HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2084 MAIN ST
WILLISBURG KY
40078-8199
US

IV. Provider business mailing address

PO BOX 188 2084 MAIN STREET
WILLISBURG KY
40078-0188
US

V. Phone/Fax

Practice location:
  • Phone: 859-375-9200
  • Fax: 859-375-9204
Mailing address:
  • Phone: 859-375-9200
  • Fax: 859-375-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number810323
License Number StateKY

VIII. Authorized Official

Name: MR. MARK LAPALME SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 859-375-9200