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General NPI Number Information
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NPI Number | 1538846944
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Entity Type | Organization
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Legal Business Name | BROKEN TO BLESSED RECOVERY INC
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1397 CHANEY PIKE
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9123
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Country | US
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Telephone | 270-465-3946
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Fax |
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Provider Business Mailing Address
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Address Line | 1397 CHANEY PIKE
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9123
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Country | US
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Telephone | 270-465-3946
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MRS. LAURA R MARCUM
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Credential | LPN, CPDM, MS
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Telephone | 270-932-1307
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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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