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General NPI Number Information
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NPI Number | 1366176919
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Entity Type | Organization
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Legal Business Name | SOLID GROUND COUNSELING & RECOVERY CENTERS LLC
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 204 S CAROL MALONE BLVD
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City | GRAYSON
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State | KY
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Zip | 41143-1368
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Country | US
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Telephone | 606-783-0023
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S CAROL MALONE BLVD
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City | GRAYSON
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State | KY
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Zip | 41143-1368
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SANDRA F CAUDILL
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Credential |
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Telephone | 606-373-4887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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