Healthcare Provider Details

I. General information

NPI: 1447621016
Provider Name (Legal Business Name): ISAIAH HOUSE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 MAIN ST
WILLISBURG KY
40078-8199
US

IV. Provider business mailing address

PO BOX 188
WILLISBURG KY
40078-0188
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number800204
License Number StateKY

VIII. Authorized Official

Name: MARY HUGHES
Title or Position: CREDENTIALING
Credential:
Phone: 859-375-9200