=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275420457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAITHFUL STEPS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2025
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 N SHADY LN
-----------------------------------------------------
City | EUBANK
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42567-7659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 645-216-8892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 N SHADY LN
-----------------------------------------------------
City | EUBANK
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42567-7660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIKE VAUGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 645-216-8892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------