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General NPI Number Information
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NPI Number | 1871013326
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Entity Type | Organization
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Legal Business Name | SUGAR CAMP HOUSE ADULT DAY HEALTH CARE
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 06/26/2017
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Provider Practice Location Address
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Address Line | 157 KY HWY 3346
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City | BOONEVILLE
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State | KY
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Zip | 41314-4131
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Country | US
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Telephone | 606-593-6405
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Fax | 606-593-7240
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Provider Business Mailing Address
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Address Line | 157 KY HWY 3346
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City | BOONEVILLE
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State | KY
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Zip | 41314
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Country | US
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Telephone | 606-593-7240
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAUL NEELEY
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Credential |
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Telephone | 606-593-6405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 750198
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License Number State | KY
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