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General NPI Number Information
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NPI Number | 1265610828
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Entity Type | Organization
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Legal Business Name | BUCKHORN LAKE AREA SUPPORT TEAM, INC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 5053 N KY HIGHWAY 15
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City | BONNYMAN
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State | KY
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Zip | 41719-8972
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Country | US
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Telephone | 606-487-1050
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Fax | 606-487-1051
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Provider Business Mailing Address
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Address Line | 5053 N KY HIGHWAY 15
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City | BONNYMAN
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State | KY
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Zip | 41719-8972
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Country | US
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Telephone | 606-487-1050
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Fax | 606-487-1051
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Authorized Official
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Title or Position | OWNER/BUSINESS MANAGER
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Name | MRS. KATRINA J BOWLING
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Credential |
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Telephone | 606-216-7438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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