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General NPI Number Information
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NPI Number | 1245765734
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Entity Type | Organization
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Legal Business Name | KENTUCKY ADDICTION CENTERS, LLC
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Dates
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Enumeration Date | 04/22/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 625 TECH DR
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City | WINCHESTER
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State | KY
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Zip | 40391-9662
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Country | US
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Telephone | 859-739-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 625 TECH DR
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City | WINCHESTER
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State | KY
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Zip | 40391-9662
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Country | US
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Telephone | 606-369-4617
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BENJAMIN D FERGUSON
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Credential | LCADC
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Telephone | 606-369-4617
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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 | 03015
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License Number State | KY
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