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General NPI Number Information
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NPI Number | 1659095024
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Entity Type | Organization
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Legal Business Name | A SILVER LINING, LLC
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 2051 LILY RD
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City | LONDON
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State | KY
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Zip | 40744-9411
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Country | US
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Telephone | 606-280-4210
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 122
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City | FALL ROCK
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State | KY
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Zip | 40932-0122
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Country | US
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Telephone | 606-594-6009
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Fax |
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | MARIETTA R FULTZ
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Credential |
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Telephone | 606-594-6009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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