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General NPI Number Information
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NPI Number | 1396567723
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Entity Type | Organization
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Legal Business Name | TIME TO SURRENDER
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 109 PARKWAY DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 270-401-6611
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Fax | 270-982-1315
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Provider Business Mailing Address
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Address Line | PO BOX 1086
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City | ELIZABETHTOWN
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State | KY
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Zip | 42702-1086
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Country | US
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Telephone | 270-401-6611
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. JARUTHA BARNETT
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Credential |
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Telephone | 270-401-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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