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General NPI Number Information
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NPI Number | 1609962091
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Entity Type | Organization
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Legal Business Name | VETERANS AFFAIRS MEDICAL CENTER
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2250 LEESTOWN RD #29-1
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City | LEXINGTON
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State | KY
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Zip | 40511-1052
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Country | US
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Telephone | 859-233-4511
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Fax | 859-281-3952
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Provider Business Mailing Address
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Address Line | 1101 VETERANS DR LEESTOWN DIVISION #29-1
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City | LEXINGTON
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State | KY
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Zip | 40502-2235
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Country | US
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Telephone | 859-233-4511
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Fax | 859-281-3952
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | MS. CYNTHIA JOAN BROWN
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Credential | LCSW
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Telephone | 859-233-4511
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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 | 1163
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License Number State | KY
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