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General NPI Number Information
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NPI Number | 1174153514
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Entity Type | Organization
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Legal Business Name | REDEMPTION ROAD RECOVERY
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 4222 HIGHWAY 830
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City | GRAY
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State | KY
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Zip | 40734-4511
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Country | US
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Telephone | 606-528-9601
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Fax | 606-523-2136
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Provider Business Mailing Address
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Address Line | 4222 HIGHWAY 830
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City | GRAY
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State | KY
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Zip | 40734-4511
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Country | US
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Telephone | 606-528-9601
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Fax | 606-523-2136
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Authorized Official
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Title or Position | CEO
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Name | RAY SCOTT PHIPPS
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Credential |
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Telephone | 606-528-9601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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