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General NPI Number Information
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NPI Number | 1619339736
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Entity Type | Organization
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Legal Business Name | CENTRAL KENTUCKY RECOVERY MANAGEMENT
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1094 US HIGHWAY 27 S STE A
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City | CYNTHIANA
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State | KY
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Zip | 41031-7078
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Country | US
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Telephone | 859-569-3145
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Fax | 859-569-3176
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Provider Business Mailing Address
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Address Line | 1094 US HIGHWAY 27 S STE A
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City | CYNTHIANA
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State | KY
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Zip | 41031-7078
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Country | US
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Telephone | 859-569-3145
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Fax | 859-569-3176
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Authorized Official
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Title or Position | OWNER
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Name | TRACY S FRYMAN
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Credential |
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Telephone | 859-569-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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