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NPI 1407579832

NPI 1407579832 : RAYS OF HOPE INTERVENTION : MONTICELLO, KY

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General NPI Number Information
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    NPI Number           |    1407579832
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    Entity Type          |    Organization 
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    Legal Business Name  |    RAYS OF HOPE INTERVENTION 
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Dates
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    Enumeration Date     |    09/21/2022
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    Last Update Date     |    09/21/2022
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Provider Practice Location Address
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    Address Line         |    950 N MAIN ST STE 2 
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    City                 |    MONTICELLO
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    State                |    KY
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    Zip                  |    42633-1557
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    Country              |    US
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    Telephone            |    606-307-6688
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    Fax                  |    606-396-8006
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Provider Business Mailing Address
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    Address Line         |    840 S MAIN ST 
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    City                 |    MONTICELLO
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    State                |    KY
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    Zip                  |    42633-2760
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    Country              |    US
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    Telephone            |    606-307-6688
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     TIM  STOCKTON 
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    Credential           |    
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    Telephone            |    606-307-6688
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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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