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General NPI Number Information
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NPI Number | 1386287837
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Entity Type | Organization
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Legal Business Name | KENTUCKY CHRISTIAN RECOVERY, LLC
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 263 HUNTSVILLE QUALITY RD STE A
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City | MORGANTOWN
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State | KY
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Zip | 42261-7395
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Country | US
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Telephone | 270-934-2024
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Fax | 270-934-2108
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Provider Business Mailing Address
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Address Line | 1118 S MAIN ST STE 3
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City | MORGANTOWN
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State | KY
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Zip | 42261-9409
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Country | US
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Telephone | 270-934-2024
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Fax | 270-934-2108
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Authorized Official
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Title or Position | OWNER
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Name | BENJAMIN THOMAS WEST
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Credential |
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Telephone | 270-799-1658
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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 |
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License Number State |
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