Healthcare Provider Details

I. General information

NPI: 1356997449
Provider Name (Legal Business Name): BEALL RECOVERY CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W LEXINGTON AVE STE C
WINCHESTER KY
40391-1290
US

IV. Provider business mailing address

1145 W LEXINGTON AVE STE C
WINCHESTER KY
40391-1290
US

V. Phone/Fax

Practice location:
  • Phone: 859-385-4093
  • Fax: 859-355-4058
Mailing address:
  • Phone: 859-385-4093
  • Fax: 859-355-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY OSBORNE
Title or Position: OWNER
Credential:
Phone: 859-385-4093