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General NPI Number Information
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NPI Number | 1730245226
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Entity Type | Organization
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Legal Business Name | STEPWORKS ADDICTION RESOURCES
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2443
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Country | US
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Telephone | 270-982-1244
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Fax | 270-982-1255
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Provider Business Mailing Address
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Address Line | 100 DIECKS DR
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2443
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Country | US
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Telephone | 270-982-1244
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Fax | 270-982-1255
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SHERRY WILEY COOMER
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Credential |
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Telephone | 270-982-1244
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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 | 810215
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License Number State | KY
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