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General NPI Number Information
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NPI Number | 1013737055
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Entity Type | Organization
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Legal Business Name | MENDED HEARTS RECOVERY LLC.
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 36 E LEXINGTON AVE UNIT A
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City | WINCHESTER
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State | KY
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Zip | 40391-2031
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Country | US
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Telephone | 606-585-4553
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Fax |
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Provider Business Mailing Address
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Address Line | 723 WILLIAMSBURG DR
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City | WINCHESTER
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State | KY
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Zip | 40391-8413
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Country | US
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Telephone | 859-967-4444
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAWN MCCARTY
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Credential | CPSS
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Telephone | 859-967-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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