=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477424752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAIAH HOUSE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2025
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4185 LEXINGTON RD
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40383-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-275-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4185 LEXINGTON RD
-----------------------------------------------------
City | VERSAILLES
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40383-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-275-9200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | LUCILLE KOEHL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-755-7433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------