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General NPI Number Information
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NPI Number | 1548024805
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Entity Type | Organization
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Legal Business Name | FMHC WELLNESS LODGE LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 190 KINGS DAUGHTERS DR
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City | FRANKFORT
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State | KY
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Zip | 40601-4104
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Country | US
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Telephone | 561-779-2123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 54330
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City | LEXINGTON
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State | KY
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Zip | 40555-4330
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Country | US
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Telephone | 561-779-2123
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SARDAR KHAN
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Credential | MSW
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Telephone | 561-779-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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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