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General NPI Number Information
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NPI Number | 1346050366
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Entity Type | Organization
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Legal Business Name | PEACEFULLY WHOLE INCORPORATED
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 163 E LOWRY LN
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City | LEXINGTON
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State | KY
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Zip | 40503-2438
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Country | US
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Telephone | 502-735-5075
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 CYPRESS ST
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City | PARIS
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State | KY
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Zip | 40361-1213
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Country | US
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Telephone | 859-287-5470
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JULIA CALVERT BYRD
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Credential |
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Telephone | 859-287-5470
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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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