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General NPI Number Information
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NPI Number | 1053934836
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Entity Type | Organization
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Legal Business Name | ROARING BROOK LLC
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Dates
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Enumeration Date | 05/27/2020
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 600 PERIMETER DR STE 125
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City | LEXINGTON
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State | KY
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Zip | 40517-4296
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Country | US
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Telephone | 866-678-8123
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Fax | 877-679-4828
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Provider Business Mailing Address
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Address Line | 600 PERIMETER DR STE 125
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City | LEXINGTON
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State | KY
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Zip | 40517-4296
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Country | US
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Telephone | 866-678-8123
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Fax | 877-679-4828
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | JOHN A SANDERS
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Credential | MD
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Telephone | 866-678-8123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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