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General NPI Number Information
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NPI Number | 1548633415
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Entity Type | Organization
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Legal Business Name | RESURRECTION TREATMENT CLINICS LLC
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1718 ALEXANDRIA DR SUITE 101
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City | LEXINGTON
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State | KY
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Zip | 40504-3144
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Country | US
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Telephone | 859-983-0678
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Fax | 859-263-1312
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Provider Business Mailing Address
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Address Line | 7145 E VIRGINIA ST STE 2000
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City | EVANSVILLE
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State | IN
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Zip | 47715-9147
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Country | US
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Telephone | 812-962-7894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE YORK
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Credential |
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Telephone | 859-276-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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