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General NPI Number Information
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NPI Number | 1629566500
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Entity Type | Organization
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Legal Business Name | KENTUCKY CHRISTIAN RECOVERY, LLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 1118 S. MAIN ST. SUITE 3
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City | MORGANTOWN
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State | KY
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Zip | 42261
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Country | US
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Telephone | 270-288-5058
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Fax | 270-288-5080
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Provider Business Mailing Address
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Address Line | 1118 S. MAIN ST. SUITE 3
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City | MORGANTOWN
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State | KY
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Zip | 42261
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Country | US
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Telephone | 270-288-5058
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Fax | 270-288-5080
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | MR. BENJAMIN THOMAS WEST
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Credential | LPCC
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Telephone | 270-799-1658
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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 |
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License Number State |
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