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General NPI Number Information
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NPI Number | 1609657568
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Entity Type | Organization
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Legal Business Name | SA ROSEBUD HOME LLC
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 234 ROSEBUD AVE
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City | IRVINE
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State | KY
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Zip | 40336-1204
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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 | 1160 BRICK HOUSE LN
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City | LEXINGTON
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State | KY
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Zip | 40509-8563
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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 | CASE MANAGER
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Name | NAJAM KHAN
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Credential | CM
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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 | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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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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Taxonomy #3
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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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