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General NPI Number Information
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NPI Number | 1780143826
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Entity Type | Organization
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Legal Business Name | BLESS THE LORD CHURCH, INC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 236 BRIDGETT DR
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City | MT STERLING
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State | KY
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Zip | 40353-1601
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Country | US
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Telephone | 859-498-7111
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Fax | 606-498-7100
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Provider Business Mailing Address
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Address Line | 236 BRIDGETT DR
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City | MT STERLING
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State | KY
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Zip | 40353-1601
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Country | US
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Telephone | 859-498-7111
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Fax | 859-498-7100
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHARLES WAYNE ROSS
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Credential | BSW, CADC
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Telephone | 859-509-3655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 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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